Marlon Joseph Broussard, PHARM D
Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Portland, OR
NPI 1508145996 · NPPES record last updated Jan 22, 2016
Key facts
- NPI
- 1508145996
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- License
- 11134 (OR)
- Practice address
- 501 N Graham St
Portland, OR 97227-1654 - Phone
- (503) 413-4225
- Fax
- (503) 413-4515
- NPI assigned
- Aug 16, 2011
- 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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0011134 | OR | MD | Pharmacist |
| 11134 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0011134 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 11134 | OR | Yes |
Addresses
Primary practice location
501 N Graham St
Portland, OR 97227-1654
Mailing address
501 N Graham St
Portland, OR 97227-1654
Phone (503) 413-4225
Other providers in Portland, OR
- Michael Brosnan
- John Paul Brotzman
- Danielle Alison Brouillard
- Adam Packard Brounstein
- Shannon Marie Broussard-Bueno
- Stephanie Broussard
- William Fred Broussard
- Jordan Brower
- Julianne Brower
- Megan Jasumback Brower
All providers in Portland, OR · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2016. 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.