Individual
COLE MICHAEL BODINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
5717 NE 138TH AVE, PORTLAND, OR 97230-3499
(503) 821-3814
Mailing address
5717 NE 138TH AVE, PORTLAND, OR 97230-3499
(503) 821-3814
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH-0018509
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0018509
PHARMACIST LICENSE
OR
Enumeration date
10/04/2021
Last updated
10/04/2021
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