Active NPI
Devon Heisler
- Pharmacy
- Gresham, OR
National Provider Identifier
1154984763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- PI-0012696
- Practice address
- 24800 SE Stark St
Gresham, OR 97030-3378 - Phone
- (503) 674-1122
- NPI assigned
- Apr 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacy | 333600000X | PI-0012696 | OR | Primary |
Addresses
Primary practice location
24800 SE Stark St
Gresham, OR 97030-3378
Mailing address
2215 SE 37TH Ave
Portland, OR 97214-5819
Phone (603) 903-3117
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PI-0012696 | OR | MD | Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555545600000",
"number": "1154984763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2215 SE 37TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972145819",
"telephone_number": "603-903-3117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24800 SE STARK ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303378",
"telephone_number": "503-674-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEISLER",
"first_name": "DEVON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-18",
"last_updated": "2019-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "OR",
"license": "PI-0012696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.