Active NPI
Jacqueline O Pham
- Pharmacist
- Beaverton, OR
National Provider Identifier
1922360262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10766
- Practice address
- 8155 SW Hall Blvd
Beaverton, OR 97008-6416 - Phone
- (503) 643-3443
- Fax
- (503) 643-4309
- NPI assigned
- Jun 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | 10766 | OR | Primary |
Addresses
Primary practice location
8155 SW Hall Blvd
Beaverton, OR 97008-6416
Mailing address
8155 SW Hall Blvd
Beaverton, OR 97008-6416
Phone (503) 643-3443
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 |
|---|---|---|---|
| 10766 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339459200000",
"number": "1922360262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8155 SW HALL BLVD",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970086416",
"telephone_number": "503-643-3443",
"fax_number": "503-643-4309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8155 SW HALL BLVD",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970086416",
"telephone_number": "503-643-3443",
"fax_number": "503-643-4309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "JACQUELINE",
"middle_name": "O",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-12",
"last_updated": "2012-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "10766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.