Active NPI
Nisse Peng, RPH, PHARMD
- Pharmacist
- Portland, OR
National Provider Identifier
1083787436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-11103
- Practice address
- 1303 NW Lovejoy St
Portland, OR 97209-2785 - Phone
- (503) 205-6751
- Fax
- (503) 205-6750
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-11103 | OR | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-11103 | OR |
Addresses
Primary practice location
1303 NW Lovejoy St
Portland, OR 97209-2785
Mailing address
1303 NW Lovejoy St
Portland, OR 97209-2785
Phone (503) 205-6751
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-11103 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467072000000",
"number": "1083787436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1303 NW LOVEJOY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092785",
"telephone_number": "503-205-6751",
"fax_number": "503-205-6750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 NW LOVEJOY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092785",
"telephone_number": "503-205-6751",
"fax_number": "503-205-6750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENG",
"first_name": "NISSE",
"credential": "RPH, PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2016-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-11103",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH-11103",
"primary": false
}
],
"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 Jun 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.