Michelle L Petersen, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

0010057 Issued in OR

Practice address

735 Spruce St
Myrtle Point, OR 97458-1154

Phone

(541) 572-5010

Fax

(541) 572-5507

NPI assigned

Aug 11, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Semperts Rexall Drug Store Inc

  • Community/Retail Pharmacy
  • Myrtle Point, OR
  • NPI 1962579540
  NPD

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249948800000",
    "number": "1063644953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 SPRUCE ST",
            "city": "MYRTLE POINT",
            "state": "OR",
            "postal_code": "974581154",
            "telephone_number": "541-572-5010",
            "fax_number": "541-572-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 SPRUCE ST",
            "city": "MYRTLE POINT",
            "state": "OR",
            "postal_code": "974581154",
            "telephone_number": "541-572-5010",
            "fax_number": "541-572-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-11",
        "last_updated": "2009-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "0010057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Yim Lee, MD
• Myrtle Point of Cascadia, LLC
• New Creations LLC 1111
• Kyle O'Hara
• Kaylie Marie Parrish
• Alex Mario Rangel
• Sapphire at Myrtle Creek LLC
• Sapphire at Myrtle Point, LLC
• Semperts Rexall Drug Store Inc

• Pharmacist in Myrtle Point, OR
• Providers in Myrtle Point, OR by specialty
• Pharmacist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2009; 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.