Alix Fredrickson, RPH

Key facts

NPI

1710169396

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X

License

9207 (OR)

Practice address

5717 NE 138TH Ave
Portland, OR 97230-3409

Phone

(503) 261-7541

Fax

(503) 261-2048

NPI assigned

Dec 5, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 21, 2025.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1710169396",
    "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": "888-658-7548"
        },
        {
            "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": "503-261-7541",
            "fax_number": "503-261-2048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "ALIX",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-05",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "WA",
            "license": "PH60225852",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "9207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

• Meredith Claire Frederick, M.D.
• Nikki Frederick, PH.D.
• Erin Fredericks, MSCN
• Linda Joyce Thimsen Fredericks, FNP
• Melissa Fredette, PH.D.
• Amanda Kristine Fredrickson, R.D.
• Annalisa Fredrickson
• Knute A Fredrickson, DMD
• Free Spirits Therapy LLC
• Free State Massage and Wellness

All providers in Portland, OR · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon