Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 1835P2201X | Pharmacist | Ambulatory Care | RPH-0015338 | OREGON | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | T-14686 | OTHER | MISSISSIPPI | MISSISSIPPI BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION |
| 2 | 5302038969 | OTHER | MICHIGAN | MICHIGAN BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION |
| 3 | PH60743255 | OTHER | WASHINGTON | WASHINGTON BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION |
| 4 | RPH-0015338 | OTHER | OREGON | OREGON BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION |
| 5 | 0202215443 | OTHER | VIRGINIA | VIRGINIA BOARD OF PHARMACY PHARMACIST LICENSE CERTIFICATION |
