Provider Demographics
NPI:1649984386
Name:TOULIS, BRANDON COLE
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:COLE
Last Name:TOULIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NW HERMOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3841
Mailing Address - Country:US
Mailing Address - Phone:863-673-6640
Mailing Address - Fax:
Practice Address - Street 1:345 SW HARRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5364
Practice Address - Country:US
Practice Address - Phone:503-327-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00193033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy