Provider Demographics
NPI:1255949285
Name:BODREAU, CHARLES WHITNEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WHITNEY
Last Name:BODREAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20233 SW JAY ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-8137
Mailing Address - Country:US
Mailing Address - Phone:971-221-8200
Mailing Address - Fax:
Practice Address - Street 1:20233 SW JAY ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-8137
Practice Address - Country:US
Practice Address - Phone:971-221-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016852183500000X, 1835P0018X
KY0214081835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist