Provider Demographics
NPI:1871677609
Name:STURGEON, MARVIN CARL (B PHARM)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:CARL
Last Name:STURGEON
Suffix:
Gender:M
Credentials:B PHARM
Other - Prefix:
Other - First Name:MONTE
Other - Middle Name:
Other - Last Name:STURGEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:B PHARM
Mailing Address - Street 1:3326 NE COUCH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3233
Mailing Address - Country:US
Mailing Address - Phone:503-233-7021
Mailing Address - Fax:
Practice Address - Street 1:1010 SW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3425
Practice Address - Country:US
Practice Address - Phone:503-205-1860
Practice Address - Fax:503-205-1849
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006937183500000X, 1835P0018X
WAPH00011046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist