Derek Andrus, RPH

Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Portland, OR

NPI 1104378199 · NPPES record last updated Oct 26, 2016

Key facts

NPI
1104378199
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
License
7623 (OR)
Practice address
5717 NW 138TH
Portland, OR 97230
Phone
(800) 548-9809
NPI assigned
Oct 26, 2016
Sex
Male
Sole proprietor
No

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
7623ORMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 7623 OR Yes

Addresses

Primary practice location

5717 NW 138TH
Portland, OR 97230

Mailing address

2351 NW Byrne Ter
Portland, OR 97229-4477
Phone (503) 621-6429

Other providers in Portland, OR

All providers in Portland, OR · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon

Sources for this page

Verify at the official NPI Registry.