Active NPI
Lacey Jo Henry, PHARM. D.
- Pharmacist
- Portland, OR
National Provider Identifier
1811220155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0011065
- Practice address
- 4325 SE 82ND Ave
Portland, OR 97266-2919 - Phone
- (503) 775-9603
- NPI assigned
- Sep 17, 2009
- Last updated
- Sep 17, 2009
- 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 | 183500000X | RPH-0011065 | OR | Primary |
Addresses
Primary practice location
4325 SE 82ND Ave
Portland, OR 97266-2919
Mailing address
4325 SE 82ND
Portland, OR 97266
Phone (503) 775-9603
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0011065 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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": "1253145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253145600000",
"number": "1811220155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4325 SE 82ND",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97266",
"telephone_number": "503-775-9603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4325 SE 82ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972662919",
"telephone_number": "503-775-9603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "LACEY",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-17",
"last_updated": "2009-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0011065",
"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 Sep 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.