Active NPI
Edwin M. Mickelson Jr., RPH
- Pharmacist
- Cornelius, OR
National Provider Identifier
1962716282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0006856
- Practice address
- 115 N 20TH Ave
Cornelius, OR 97113-7471 - Phone
- (503) 357-0762
- Fax
- (503) 357-0904
- NPI assigned
- Jul 28, 2010
- Sex
- Male
- 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-0006856 | OR | Primary |
Addresses
Primary practice location
115 N 20TH Ave
Cornelius, OR 97113-7471
Mailing address
115 N 20TH Ave
Cornelius, OR 97113-7471
Phone (503) 357-0762
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0006856 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pharmacy
- Cornelius, OR
- NPI 1770598765
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1962716282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 N 20TH AVE",
"city": "CORNELIUS",
"state": "OR",
"postal_code": "971137471",
"telephone_number": "503-357-0762",
"fax_number": "503-357-0904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 N 20TH AVE",
"city": "CORNELIUS",
"state": "OR",
"postal_code": "971137471",
"telephone_number": "503-357-0762",
"fax_number": "503-357-0904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKELSON",
"first_name": "EDWIN",
"middle_name": "M.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-28",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0006856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cornelius, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.