Active NPI
Caleb Jackson
- Pharmacist
- Portland, OR
National Provider Identifier
1255235495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0021201
- Practice address
- 4805 NE Glisan St
Portland, OR 97213-2933 - Phone
- (719) 310-3411
- NPI assigned
- Oct 2, 2026
- Last updated
- Oct 2, 2026
- Sex
- Male
- 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-0021201 | OR | Primary |
Addresses
Primary practice location
4805 NE Glisan St
Portland, OR 97213-2933
Mailing address
1411 NE 16TH Ave Apt 120
Portland, OR 97232-4408
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-0021201 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790899200000",
"number": "1255235495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 NE 16TH AVE APT 120",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972324408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "719-310-3411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CALEB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-10-02",
"last_updated": "2026-10-02",
"certification_date": "2026-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0021201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.