Provider Demographics
NPI:1194159947
Name:DAWSON, MONICA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:DAWSON
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 1:1650 NW SALTZMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4653
Mailing Address - Country:US
Mailing Address - Phone:360-791-7839
Mailing Address - Fax:503-618-1928
Practice Address - Street 1:1555 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4271
Practice Address - Country:US
Practice Address - Phone:503-666-9476
Practice Address - Fax:503-618-1928
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013639183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist