NPIMap

Individual provider Active NPI

Brandon Clegg, PHARM D

  • Pharmacist
  • Medford, OR
National Provider Identifier
1942501622
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0011068 Issued in OR
Practice address
3169 Crater Lake Hwy
Medford, OR 97504-9179
Phone
(541) 774-4346
Fax
(541) 774-4348
NPI assigned
Nov 10, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0011068 OR Primary

Addresses

Primary practice location

3169 Crater Lake Hwy
Medford, OR 97504-9179

Mailing address

3169 Crater Lake Hwy
Medford, OR 97504-9179
Phone (541) 774-4346

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

LicenseStateTypeSpecialty
0011068ORMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew 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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289347200000",
    "number": "1942501622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3169 CRATER LAKE HWY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049179",
            "telephone_number": "541-774-4346",
            "fax_number": "541-774-4348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3169 CRATER LAKE HWY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049179",
            "telephone_number": "541-774-4346",
            "fax_number": "541-774-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEGG",
        "first_name": "BRANDON",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-10",
        "last_updated": "2010-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "0011068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.