Jeffrey Dversdal
Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Fairview, OR
NPI 1104618362 · NPPES record last updated May 21, 2025
Key facts
- NPI
- 1104618362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- License
- RPH-0010048 (OR)
- Practice address
- 3768 NE Fairview Lake Way
Fairview, OR 97024-7758 - Phone
- (503) 459-2474
- NPI assigned
- May 21, 2025
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0010048 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-0010048 | OR | Yes |
Addresses
Primary practice location
3768 NE Fairview Lake Way
Fairview, OR 97024-7758
Mailing address
3768 NE Fairview Lake Way
Fairview, OR 97024-7758
Phone (503) 459-2474
Other providers in Fairview, OR
- Brian Garrett Cox
- Monika Renee Deshazer
- James Divine
- Devin Dolan
- Angela Kristine Downing
- Catherine Dynes
- Chad Emmanuel Eaddy
- Ebenezer LLC
- Leanne Ensey
- Fairview Healing Home LLC
All providers in Fairview, OR · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.