Active NPI
Gary Edwin Nelson, R.PH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Portland, OR
National Provider Identifier
1396290201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 7022
- Practice address
- 1700 NE 102ND Ave
Portland, OR 97220-3804 - Phone
- (866) 279-4581
- NPI assigned
- Aug 20, 2016
- 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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 7022 | OR | Primary |
Addresses
Primary practice location
1700 NE 102ND Ave
Portland, OR 97220-3804
Mailing address
3667 SE Durango PL
Gresham, OR 97080-7357
Phone (503) 341-2712
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7022 | 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": "1471651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588032000000",
"number": "1396290201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3667 SE DURANGO PL",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970807357",
"telephone_number": "503-341-2712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 NE 102ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972203804",
"telephone_number": "866-279-4581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "GARY",
"middle_name": "EDWIN",
"name_prefix": "Mr.",
"credential": "R.PH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-20",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "7022",
"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 Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.