Russell Roy Cross, RPH
Individual provider Active NPI Pharmacist · Sandy, OR
NPI 1447595020 · NPPES record last updated Apr 27, 2017
Key facts
- NPI
- 1447595020
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 7415 (OR)
- Practice address
- 16625 326ND Ave
Sandy, OR 97055 - Phone
- (503) 668-2363
- Fax
- (503) 668-2327
- NPI assigned
- Dec 7, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7415 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Meyer Stores Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7415 | OR | Yes |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 7415 | OR |
Addresses
Primary practice location
16625 326ND Ave
Sandy, OR 97055
Mailing address
16625 SE 362ND Dr
Sandy, OR 97055-9247
Phone (503) 668-2363
Other providers in Sandy, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.