Active NPI
The Ta
- Pharmacist
- Portland, OR
National Provider Identifier
1487947792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10498
- Practice address
- 2440 SE Cesar E Chavez Blvd
Portland, OR 97214-5920 - Phone
- (503) 234-9408
- Fax
- (503) 238-5903
- NPI assigned
- May 18, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10498 | OR | Primary |
Addresses
Primary practice location
2440 SE Cesar E Chavez Blvd
Portland, OR 97214-5920
Mailing address
2440 SE Cesar E Chavez Blvd
Portland, OR 97214-5920
Phone (503) 234-9408
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 183500000X | Medicaid | OR |
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 |
|---|---|---|---|
| 10498 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305676800000",
"number": "1487947792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2440 SE CESAR E CHAVEZ BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972145920",
"telephone_number": "503-234-9408",
"fax_number": "503-238-5903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2440 SE CESAR E CHAVEZ BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972145920",
"telephone_number": "503-234-9408",
"fax_number": "503-238-5903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TA",
"first_name": "THE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-18",
"last_updated": "2011-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "10498",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "183500000X",
"state": "OR"
}
],
"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 May 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.