Active NPI
Kelsey Bruck
- Pharmacist
- McMinnville, OR
National Provider Identifier
1831644400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0015446
- Practice address
- 2490 NE Highway 99W
McMinnville, OR 97128-9204 - Phone
- (503) 435-3125
- NPI assigned
- Aug 23, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0015446 | OR | Primary |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | RPH-0015446 | OR |
Addresses
Primary practice location
2490 NE Highway 99W
McMinnville, OR 97128-9204
Mailing address
2490 NE Highway 99W
McMinnville, OR 97128-9204
Phone (503) 435-3125
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 |
|---|---|---|---|
| 0015446 | OR | MD | Pharmacist |
| RPH-0015446 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- McMinnville, OR
- NPI 1114956158
-
- Community/Retail Pharmacy
- Queen Creek, AZ
- NPI 1730040973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487635200000",
"number": "1831644400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2490 NE HIGHWAY 99W",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971289204",
"telephone_number": "503-435-3125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2490 NE HIGHWAY 99W",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971289204",
"telephone_number": "503-435-3125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCK",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-23",
"last_updated": "2017-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "0015446",
"primary": true
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "RPH-0015446",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.