Provider Demographics
NPI:1104216910
Name:GAMELIER, LOGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:GAMELIER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5257 NE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1965
Mailing Address - Country:US
Mailing Address - Phone:503-351-0333
Mailing Address - Fax:971-202-5555
Practice Address - Street 1:315 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1703
Practice Address - Country:US
Practice Address - Phone:503-351-0333
Practice Address - Fax:503-416-1382
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298164183500000X
PARP448964183500000X
ORRPH-0017620183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist