Micah Evan Walter, PHARM.D., R.PH.,CIP

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

RP-0011846 Issued in OR

Practice address

314 S. Main St.
Canyonville, OR 97417

Phone

(541) 839-4452

NPI assigned

Aug 13, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy, Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gordons Pharmacy & Gifts LLC

  dba Gordon's Pharmacy and Gifts

  • Community/Retail Pharmacy
  • Canyonville, OR
  • NPI 1831236991
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1184971806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E OAK ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973553222",
            "telephone_number": "541-451-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S. MAIN ST.",
            "city": "CANYONVILLE",
            "state": "OR",
            "postal_code": "97417",
            "telephone_number": "541-839-4452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "MICAH",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "PHARM.D., R.PH.,CIP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-13",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "0011846",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "RP-0011846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelly Rea Sullens, DMD
• Sarah L Swanson
• Nicole C Taber, LMT
• Anandita Tiwari, M.D.
• Tina Joy Vernoy, LMT
• Harlan Lee White, DMD
• Ronald E Wilmot

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Canyonville, OR
• Providers in Canyonville, OR by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.