Provider Demographics
NPI:1538402664
Name:GILCHRIST, BRIAN C (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:GILCHRIST
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 1:916 W EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3035
Mailing Address - Country:US
Mailing Address - Phone:360-213-2236
Mailing Address - Fax:360-213-2238
Practice Address - Street 1:207 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ESTACADA
Practice Address - State:OR
Practice Address - Zip Code:97023
Practice Address - Country:US
Practice Address - Phone:360-838-2195
Practice Address - Fax:360-213-2238
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009103183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0009103OtherPHARMACIST LICENSE
ORRPH-0009103-POtherPHARMACIST PRECEPTOR LICENSE