Active NPI
Kyle Thomas Dickens, RPH,PHARMD,MHA
- Pharmacist
- Lebanon, OR
National Provider Identifier
1629628342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0017457
- Practice address
- 30 E Oak St
Lebanon, OR 97355-3222 - Phone
- (541) 451-8020
- Fax
- (541) 451-8027
- NPI assigned
- Sep 14, 2019
- 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 | RPH-0017457 | OR | Primary |
Addresses
Primary practice location
30 E Oak St
Lebanon, OR 97355-3222
Mailing address
582 Casting St SE
Albany, OR 97322-4911
Phone (209) 581-8138
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH-0017457 | Other | OR | OREGON BOARD OF PHARMACY |
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0017457 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638144000000",
"number": "1629628342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "582 CASTING ST SE",
"city": "ALBANY",
"state": "OR",
"postal_code": "973224911",
"telephone_number": "209-581-8138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 E OAK ST",
"city": "LEBANON",
"state": "OR",
"postal_code": "973553222",
"telephone_number": "541-451-8020",
"fax_number": "541-451-8027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKENS",
"first_name": "KYLE",
"middle_name": "THOMAS",
"credential": "RPH,PHARMD,MHA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-14",
"last_updated": "2021-11-29",
"certification_date": "2021-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0017457",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON BOARD OF PHARMACY",
"identifier": "RPH-0017457",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.