Provider Demographics
NPI:1710436241
Name:CARLSON, SHERRY (RPH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5381 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6447
Mailing Address - Country:US
Mailing Address - Phone:855-718-7759
Mailing Address - Fax:503-547-1285
Practice Address - Street 1:5381 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6447
Practice Address - Country:US
Practice Address - Phone:855-718-7759
Practice Address - Fax:503-547-1285
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9003183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist