Provider Demographics
NPI:1669257747
Name:KERN, DAVID BRUCE (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:KERN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12044 SW REDBERRY CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1527
Mailing Address - Country:US
Mailing Address - Phone:224-277-3289
Mailing Address - Fax:
Practice Address - Street 1:7525 SW BARNES RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6203
Practice Address - Country:US
Practice Address - Phone:503-203-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist