Active NPI
Jeffrey Mangum
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Portland, OR
National Provider Identifier
1366724551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- RPH-0013850
- Practice address
- 4849 NE 138TH Ave
Portland, OR 97230-3401 - Phone
- (503) 257-3935
- Fax
- (503) 253-3747
- NPI assigned
- Sep 13, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-0013850 | OR | Primary |
| Pharmacist | 183500000X | PH00017370 | WA |
Addresses
Primary practice location
4849 NE 138TH Ave
Portland, OR 97230-3401
Mailing address
4849 NE 138TH Ave
Portland, OR 97230-3401
Phone (503) 257-3935
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 |
|---|---|---|---|
| PH00017370 | WA | MD | Pharmacist |
| RPH-0013850 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451520000000",
"number": "1366724551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4849 NE 138TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972303401",
"telephone_number": "503-257-3935",
"fax_number": "503-253-3747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4849 NE 138TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972303401",
"telephone_number": "503-257-3935",
"fax_number": "503-253-3747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGUM",
"first_name": "JEFFREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-13",
"last_updated": "2015-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH-0013850",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00017370",
"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 Dec 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.