Individual provider Active NPI

Christie Stoneback, PHARM.D.

  • Pharmacist
  • Clackamas, OR
National Provider Identifier
1386018794
Registry record updated Jan 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0010310 Issued in OR
Practice address
16300 SE Evelyn St
Clackamas, OR 97015-9515
Phone
(503) 305-9799
Fax
(623) 869-1521
NPI assigned
Nov 23, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0010310 OR Primary
Pharmacist 183500000X 55159 CA
Pharmacist 183500000X PH00070254 WA
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X RPH-0010310 OR

Addresses

Primary practice location

16300 SE Evelyn St
Clackamas, OR 97015-9515

Mailing address

16300 SE Evelyn St
Clackamas, OR 97015-9515
Phone (503) 305-9799

Other names 1

  • Dr. Christie Wyatt Former name

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
55159CAMDMarriage & Family Therapist
0010310ORMDPharmacist
PH00070254WAMDPharmacist
RPH-0010310ORMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

NPI Registry JSON

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1386018794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16300 SE EVELYN ST",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159515",
            "telephone_number": "503-305-9799",
            "fax_number": "623-869-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16300 SE EVELYN ST",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159515",
            "telephone_number": "503-305-9799",
            "fax_number": "623-869-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STONEBACK",
        "first_name": "CHRISTIE",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-23",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "0010310",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "55159",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00070254",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "RPH-0010310",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTIE",
            "last_name": "WYATT",
            "prefix": "DR.",
            "credential": "PHARM.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; 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.