Active NPI
Mary Lisa Refailov
- Pharmacist
- Gold Beach, OR
National Provider Identifier
1164162178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0017368
- Practice address
- 29670 Ellensburg Ave
Gold Beach, OR 97444-8701 - Phone
- (541) 247-4544
- Fax
- (541) 247-2604
- NPI assigned
- Mar 29, 2022
- Last updated
- Apr 5, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0017368 | OR | Primary |
Addresses
Primary practice location
29670 Ellensburg Ave
Gold Beach, OR 97444-8701
Mailing address
29670 Ellensburg Ave
Gold Beach, OR 97444-8701
Phone (541) 247-4544
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 |
|---|---|---|---|
| RPH-0017368 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mahant LLC | Past | Accepting new patients | |
| Yantis Enterprises Inc | 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": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649116800000",
"number": "1164162178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29670 ELLENSBURG AVE",
"city": "GOLD BEACH",
"state": "OR",
"postal_code": "974448701",
"telephone_number": "541-247-4544",
"fax_number": "541-247-2604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29670 ELLENSBURG AVE",
"city": "GOLD BEACH",
"state": "OR",
"postal_code": "974448701",
"telephone_number": "541-247-4544",
"fax_number": "541-247-2604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REFAILOV",
"first_name": "MARY LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-29",
"last_updated": "2022-04-05",
"certification_date": "2022-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0017368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gold Beach, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.