Provider Demographics
NPI:1801601000
Name:SAN, BRANDON SOK (PHARMD STUDENT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SOK
Last Name:SAN
Suffix:
Gender:M
Credentials:PHARMD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-8006
Mailing Address - Country:US
Mailing Address - Phone:360-624-5323
Mailing Address - Fax:
Practice Address - Street 1:222 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:206-880-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0014127390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program