Gaylen Dahle, RPH – Pharmacist in Vancouver, WA

Key facts

NPI: 1396008017
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: PH00066350 (WA)
Practice address: 8300 NE 137TH Ave
Vancouver, WA 98682-3085
Phone: (360) 883-1865
Fax: (360) 883-6427
NPI assigned: Jun 18, 2012
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Registered Pharmacist

State licenses

License	State	Type	Specialty
PH00066350	WA	MD	Pharmacist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	PH00066350	WA	Yes

Addresses

Primary practice location

8300 NE 137TH Ave
Vancouver, WA 98682-3085

Mailing address

4010 SE 170TH CT
Vancouver, WA 98683-8801
Phone (360) 892-0036

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 18, 2012.

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339977600000",
    "number": "1396008017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 SE 170TH CT",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986838801",
            "telephone_number": "360-892-0036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 NE 137TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823085",
            "telephone_number": "360-883-1865",
            "fax_number": "360-883-6427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLE",
        "first_name": "GAYLEN",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-18",
        "last_updated": "2012-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00066350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

All providers in Vancouver, WA · Pharmacist in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2012. 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.

Verify at the official NPI Registry.