Active NPI
Ann L Holler
- Pharmacist
- Portland, OR
National Provider Identifier
1255625026
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11706
- Practice address
- 6030 SW 55TH Dr
Portland, OR 97221-1603 - Phone
- (503) 953-4697
- NPI assigned
- Jun 8, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11706 | OR | Primary |
| Pharmacist | 183500000X | 21856 | WA |
Addresses
Primary practice location
6030 SW 55TH Dr
Portland, OR 97221-1603
Mailing address
6030 SW 55TH Dr
Portland, OR 97221-1603
Phone (503) 953-4697
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 |
|---|---|---|---|
| 11706 | OR | MD | Pharmacist |
| 21856 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1255625026",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6030 SW 55TH DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972211603",
"telephone_number": "503-953-4697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6030 SW 55TH DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972211603",
"telephone_number": "503-953-4697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLER",
"first_name": "ANN",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-08",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "11706",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "21856",
"primary": false
}
],
"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 Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.