Active NPI
Raymond Paul Micciche III, R.PH.
- Pharmacist
- Beaverton, OR
National Provider Identifier
1063728095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9147
- Practice address
- 14600 SW Murray Scholls Dr Ste 201
Beaverton, OR 97007-9712 - Phone
- (503) 579-1878
- Fax
- (503) 579-0988
- NPI assigned
- Aug 27, 2010
- Last updated
- Aug 27, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9147 | OR | Primary |
Addresses
Primary practice location
14600 SW Murray Scholls Dr Ste 201
Beaverton, OR 97007-9712
Mailing address
14600 SW Murray Scholls Dr Ste 201
Beaverton, OR 97007-9712
Phone (503) 579-1878
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
| License | State | Type | Specialty |
|---|---|---|---|
| 9147 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282867200000",
"number": "1063728095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14600 SW MURRAY SCHOLLS DR STE 201",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970079712",
"telephone_number": "503-579-1878",
"fax_number": "503-579-0988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14600 SW MURRAY SCHOLLS DR STE 201",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970079712",
"telephone_number": "503-579-1878",
"fax_number": "503-579-0988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICCICHE",
"first_name": "RAYMOND",
"middle_name": "PAUL",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-27",
"last_updated": "2010-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "9147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.