Active NPI
Mary Flack
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Union Gap, WA
National Provider Identifier
1609304864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- RPH-0015567
- Practice address
- 1211 Ahtanum Ridge Dr
Union Gap, WA 98903-1813 - Phone
- (509) 525-5200
- NPI assigned
- May 31, 2017
- Last updated
- May 14, 2025
- Sex
- Female
- 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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-0015567 | OR | Primary |
Addresses
Primary practice location
1211 Ahtanum Ridge Dr
Union Gap, WA 98903-1813
Mailing address
245 Sherman St Apt 225
Sutherlin, OR 97479-7411
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 |
|---|---|---|---|
| RPH-0015567 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747180800000",
"number": "1609304864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 SHERMAN ST APT 225",
"city": "SUTHERLIN",
"state": "OR",
"postal_code": "974797411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 AHTANUM RIDGE DR",
"city": "UNION GAP",
"state": "WA",
"postal_code": "989031813",
"telephone_number": "509-525-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLACK",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-31",
"last_updated": "2025-05-14",
"certification_date": "2025-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH-0015567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Union Gap, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.