Active NPI
Debra Lynn Carroll, RPH
- Pharmacist
- Portland, OR
National Provider Identifier
1609050574
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9410
- Practice address
- 5717 NE 138TH Ave
Portland, OR 97230-3409 - Phone
- (503) 261-7900
- Fax
- (503) 261-7978
- NPI assigned
- Dec 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 9410 | OR | Primary |
Addresses
Primary practice location
5717 NE 138TH Ave
Portland, OR 97230-3409
Mailing address
5717 NE 138TH Ave
Portland, OR 97230-3409
Phone (503) 261-7900
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 |
|---|---|---|---|
| 9410 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198713600000",
"number": "1609050574",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5717 NE 138TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972303409",
"telephone_number": "503-261-7900",
"fax_number": "503-261-7978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5717 NE 138TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972303409",
"telephone_number": "503-261-7900",
"fax_number": "503-261-7978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "DEBRA",
"middle_name": "LYNN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-27",
"last_updated": "2007-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "9410",
"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 Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.