Provider Demographics
NPI:1912594102
Name:STONE, BRANDI (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6616 SE STEELE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5324
Mailing Address - Country:US
Mailing Address - Phone:503-830-3910
Mailing Address - Fax:
Practice Address - Street 1:3527 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3401
Practice Address - Country:US
Practice Address - Phone:503-760-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0001450183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician