Individual provider Active NPI

Ethan James Dentler, RPH

  • Pharmacist
  • Portland, OR
National Provider Identifier
1063378255
Registry record updated Jul 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0020877 Issued in OR
Practice address
4849 NE 138TH Ave
Portland, OR 97230-3401
Phone
(503) 257-3935
NPI assigned
Dec 31, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0020877 OR Primary

Addresses

Primary practice location

4849 NE 138TH Ave
Portland, OR 97230-3401

Mailing address

18452 SE Stephens St
Portland, OR 97233-5537

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
0020877ORMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1063378255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18452 SE STEPHENS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4849 NE 138TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972303401",
            "telephone_number": "503-257-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENTLER",
        "first_name": "ETHAN",
        "middle_name": "JAMES",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-31",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "0020877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.