Active NPI
Joshua Petrisor
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Portland, OR
National Provider Identifier
1649867227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- RPH-0017693
- Practice address
- 7700 SW Beaverton Hillsdale Hwy
Portland, OR 97225-2101 - Phone
- (503) 203-4033
- NPI assigned
- Dec 29, 2020
- Last updated
- Feb 1, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0017693 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-0017693 | OR | Primary |
Addresses
Primary practice location
7700 SW Beaverton Hillsdale Hwy
Portland, OR 97225-2101
Mailing address
17885 SW Jay St
Beaverton, OR 97003-3771
Phone (503) 619-5900
Other practice location 1
8145 SE 17th Ave
Portland, OR 97202-6718
Phone (503) 382-2253
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-0017693 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oregon CVS Pharmacy LLC | Current | Accepting new patients | |
| Oregon CVS Pharmacy LLC | Past | Accepting new patients | |
| Fred Meyer Stores Inc. | Past | Accepting new patients |
Locations
8145 SE 17th Ave
Portland, OR 97202
Phone (503) 382-2253
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612137600000",
"number": "1649867227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17885 SW JAY ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970033771",
"telephone_number": "503-619-5900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7700 SW BEAVERTON HILLSDALE HWY",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972252101",
"telephone_number": "503-203-4033"
}
],
"practiceLocations": [
{
"address_1": "8145 SE 17th Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972026718",
"country_code": "US",
"telephone_number": "503-382-2253",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETRISOR",
"first_name": "JOSHUA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-29",
"last_updated": "2021-02-01",
"certification_date": "2021-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0017693",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH-0017693",
"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 Feb 1, 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.