PHILLIP C LACY (NPI# 1215429394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215429394 |
| Entity Type | Individual |
| Full Name | PHILLIP C LACY |
| Credential | CPHT |
| Practice Address |
12360 E Burnside St Portland OR 97233-1042 |
| Mailing Address |
1776 Sw Madison St Portland OR 97205-1715 |
| Practice Telephone | 9712794800 |
| Practice Fax Number | 9712792051 |
| Mailing Telephone | 5032241044 |
| Mailing Fax Number | 5036212235 |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2018-06-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183700000X | Pharmacy Technician | CPT-0011115 | OR | Pharmacy Service Providers |
| Street Address |
12360 E BURNSIDE ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97233-1042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508856188 | Artice E Geary | Social Worker | 12360 E Burnside St, Portland, OR 97233-1042 | 2005-10-25 |
| 1487262937 | Erica P Woody | Counselor | 12360 E Burnside St, Portland, OR 97233-1042 | 2020-07-21 |
| 1609416155 | Cara A Koch | Counselor | 12360 E Burnside St, Portland, OR 97233-1042 | 2020-01-13 |
| 1245878552 | Janelle M Bombara | Dietitian, Registered | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-12-17 |
| 1932756707 | Holly A Fay | Registered Nurse | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-08-26 |
| 1013570548 | Christa R Andreasen | Registered Nurse | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-04-19 |
| 1679046965 | Emerson N Begay | Pharmacy Technician | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-01-09 |
| 1992205223 | Sarah E Bruno | Social Worker | 12360 E Burnside St, Portland, OR 97233-1042 | 2018-02-13 |
| 1093233868 | Sarah S Rivera | Peer Specialist | 12360 E Burnside St, Portland, OR 97233-1042 | 2017-08-31 |
| 1689114928 | Cathy C Harrison | Registered Nurse | 12360 E Burnside St, Portland, OR 97233-1042 | 2017-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205448164 | Moore Therapy Services, LLC | Behavioral Analyst | 2053 Se 181st Ave, Portland, OR 97233 | 2020-08-20 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1427573443 | Sunshine Ahc | In Home Supportive Care | 2217 Se 156th Ave, Portland, OR 97233 | 2017-08-10 |
| 1538609433 | Nathaniel Davis Jr. | Counselor | 8915 Se Center St, Tigard, OR 97233 | 2017-02-27 |
| 1154878627 | Oregon Outreach Inc | Case Management | 1740 South East 139th Avenue, Portland, OR 97233 | 2016-09-01 |
| 1023461019 | Julianne Baltzley | Counselor | 2409 Se 149th Avenue, Portland, OR 97233 | 2016-07-14 |
| 1710332143 | Emma Slater | Counselor | 12360 Se Burnside, Portland, OR 97233 | 2016-05-04 |
| 1245621952 | Gregory Brett Bledsoe | Counselor | 1427 Se 182nd Ave., Portland, OR 97233 | 2015-02-17 |
| 1396149852 | Jacqueline Bension | Counselor | 1705 Se 122nd Ave, Portland, OR 97233 | 2014-10-13 |
| 1700206950 | Olga I Zlatova I | Dental Hygienist | 325 Se 154th Ave, Portland, OR 97233 | 2014-04-25 |
| Find all providers in zip 97233 | ||||
| Taxonomy Code | 183700000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacy Technician |
| A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |
| Notes: Source: Pharmacy Technician Certification Board, www.ptcb.org [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487961272 | Peter James | Pharmacy Technician | 1215 Nw 23rd Ave, Portland, OR 97210-2905 | 2010-09-01 |
| 1780707547 | Ronald Johnson I | Pharmacy Technician | 3710 Southwest Us Veterans Hospital Road, Portland, OR 97239 | 2007-04-09 |
| 1700403177 | Sarn Tsio Saechao | Pharmacy Technician | 5329 Ne Mlk Jr Blvd, Portland, OR 97211-3237 | 2020-07-01 |
| 1205453693 | Jason Anderson | Pharmacy Technician | 619 Nw 6th Ave Fl 7, Portland, OR 97209-3964 | 2020-07-01 |
| 1356968986 | Elizabeth Mitchell | Pharmacy Technician | 619 Nw 6th Ave Fl 7, Portland, OR 97209-3964 | 2020-06-30 |
| 1851918379 | Rolando Quinones | Pharmacy Technician | 5329 Ne Mlk Jr Blvd, Portland, OR 97211-3237 | 2020-06-30 |
| 1790302347 | Tamara Williams | Pharmacy Technician | 619 Nw 6th Ave Fl 1, Portland, OR 97209-3964 | 2020-06-30 |
| 1881211522 | Justin Castro | Pharmacy Technician | 619 Nw 6th Ave Fl 1, Portland, OR 97209-3964 | 2020-06-29 |
| 1699392332 | Brady Armstrong | Pharmacy Technician | 9000 N Lombard St, Portland, OR 97203-3006 | 2020-06-29 |
| 1780201426 | Tim Richard Criswell | Pharmacy Technician | 619 Nw 6th Ave, Portland, OR 97209-3964 | 2020-06-29 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.