Provider Demographics
NPI:1356966741
Name:BROWN, MATTHEW RAYMOND (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RAYMOND
Last Name:BROWN
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 1:1010 SW JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3425
Mailing Address - Country:US
Mailing Address - Phone:503-205-1860
Mailing Address - Fax:503-205-1853
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:503-205-1853
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00179441835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist