Kate R Frederick, RPH – Pharmacist in Portland, OR

Key facts

NPI: 1588096945
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: 7041 (OR)
Practice address: 16100 SW 72ND Ave
Portland, OR 97224-7745
Phone: (503) 626-9436
Fax: (503) 372-1792
NPI assigned: Aug 7, 2013
Sex: Female
Sole proprietor: Yes

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
7041	OR	MD	General Practice Dentistry

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	7041	OR	Yes

Addresses

Primary practice location

16100 SW 72ND Ave
Portland, OR 97224-7745

Mailing address

16100 SW 72ND Ave
Portland, OR 97224-7745
Phone (503) 626-9436

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 7, 2013.

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375833600000",
    "number": "1588096945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16100 SW 72ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247745",
            "telephone_number": "503-626-9436",
            "fax_number": "503-372-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16100 SW 72ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247745",
            "telephone_number": "503-626-9436",
            "fax_number": "503-372-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "KATE",
        "middle_name": "R",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-07",
        "last_updated": "2013-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "7041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

All providers in Portland, OR · Pharmacist in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2013. 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.

Verify at the official NPI Registry.