Provider Demographics
NPI:1952521064
Name:WILMARTH, VINCENT P (RPH)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:P
Last Name:WILMARTH
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 1:4805 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2917
Mailing Address - Country:US
Mailing Address - Phone:503-239-4453
Mailing Address - Fax:503-280-1327
Practice Address - Street 1:3030 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1851
Practice Address - Country:US
Practice Address - Phone:503-280-1333
Practice Address - Fax:503-280-1327
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist