Charles Whitney Bodreau, PHARMD
Individual provider Active NPI Pharmacist · Aloha, OR
NPI 1255949285 · NPPES record last updated Jul 15, 2020
Key facts
- NPI
- 1255949285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0016852 (OR)
- Practice address
- 20233 SW Jay St
Aloha, OR 97003-8137 - Phone
- (971) 221-8200
- NPI assigned
- Jul 15, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021408 | KY | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| 0016852 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Interoperability endpoints
- cbodreau780365@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0016852 | OR | Yes |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 0016852 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 021408 | KY |
Addresses
Primary practice location
20233 SW Jay St
Aloha, OR 97003-8137
Mailing address
20233 SW Jay St
Aloha, OR 97003-8137
Phone (971) 221-8200
Other providers in Aloha, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.