Provider Demographics
NPI:1700079506
Name:DOTTER, MICHAEL THOMAS (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:DOTTER
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 1:10202 SE 32ND AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-3610
Mailing Address - Country:US
Mailing Address - Phone:503-513-2122
Mailing Address - Fax:503-513-2105
Practice Address - Street 1:10202 SE 32ND AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-3610
Practice Address - Country:US
Practice Address - Phone:503-513-2122
Practice Address - Fax:503-513-2105
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110691835P1200X
OR0011069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
326676OtherEMPLOYEE #