Active NPI
Ryan Amos Mickelson, PHARMD, BCPS
- Pharmacist
- Salem, OR
National Provider Identifier
1437480316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0011121
- Practice address
- 3750 Chemawa Rd NE
Salem, OR 97305-1119 - Phone
- (503) 304-7600
- NPI assigned
- Jan 16, 2010
- Last updated
- Jan 16, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15475-040 | WI | |
| Pharmacist | 183500000X | RPH-0011121 | OR | Primary |
| Pharmacotherapy Pharmacist | 1835P1200X | BCPS 308009953 | OR |
Addresses
Primary practice location
3750 Chemawa Rd NE
Salem, OR 97305-1119
Mailing address
245 SW Hooker St
Apt 1
Portland, OR 97201-4774
Phone (608) 212-9204
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
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0011121 | OR | MD | Pharmacist |
| 15475-040 | WI | MD | Pharmacist |
| BCPS 308009953 | OR | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263600000000",
"number": "1437480316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 SW HOOKER ST",
"address_2": "APT 1",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972014774",
"telephone_number": "608-212-9204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3750 CHEMAWA RD NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973051119",
"telephone_number": "503-304-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKELSON",
"first_name": "RYAN",
"middle_name": "AMOS",
"name_prefix": "Mr.",
"credential": "PHARMD, BCPS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-16",
"last_updated": "2010-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "15475-040",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0011121",
"primary": true
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "OR",
"license": "BCPS 308009953",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
- Michaela Grillo LLC
- Rodney Douglas Michaels, MD
- Monica Michelotti
- Geary Joe Michels, D.C.
- Connie Jo Mickelson, RD, LD
- Sean Alexander Mickelson, MS, LPC
- Micronesian Islander Community
- Mid Valley Counseling Center Inc
- Mid Valley Employees Benefit Trust
- Mid Valley Medical Home LLC (Mid Valley Physicians Home Health)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.