DR. CAMILLE TACKETT (NPI# 1568797868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568797868 |
| Entity Type | Individual |
| Full Name | DR. CAMILLE TACKETT |
| Credential | PHARMD. |
| Practice Address |
3500 Se 26th Ave Portland OR 97202-2901 |
| Mailing Address |
Po Box 2718 Portland OR 97208-2718 |
| Practice Telephone | 5037972156 |
| Mailing Telephone | 5037972156 |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2020-10-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | S013265 | AZ | Pharmacy Service Providers |
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
RPH-0013489 | OR | Pharmacy Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2858 N Pinal Ave, Casa Grande, AZ 851227917 | 5204264701 | 5204264704 |
| Street Address |
3500 SE 26TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97202-2901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528003910 | Healthy Options Inc | Durable Medical Equipment & Medical Supplies | 3500 Se 26th Ave, Portland, OR 97202-2901 | 2006-06-18 |
| 1013516525 | Melissa Ann Cicelske | Pharmacist | 3500 Se 26th Ave, Portland, OR 97202-2901 | 2020-10-26 |
| 1760081475 | Forrest Roger Farrington | Pharmacist | 3500 Se 26th Ave, Portland, OR 97202-2901 | 2020-10-22 |
| 1417294521 | Andrea Marie Bertoni | Pharmacist | 3500 Se 26th Ave, Portland, OR 97202-2901 | 2013-01-09 |
| 1295901197 | Healthy Options Inc. | Pharmacy | 3500 Se 26th Ave, Portland, OR 97202-2901 | 2008-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073143442 | Carewell LLC | Counselor | Portland River Park Center, 205 Se Spokane St Suite 358, Portland, OR 97202 | 2020-01-24 |
| 1588226765 | Melissa Lynn Hartley | Counselor | 1235 Se Division St. Suite 103, Portland, OR 97202 | 2019-07-08 |
| 1275192999 | Kimberly Rae Kilgore | Counselor | 5509 Se 22nd St #3a, Portland, OR 97202 | 2019-06-06 |
| 1639736069 | Kyra Steinhauer | Social Worker | 3145 Se Powell Blvd, Portland, OR 97202 | 2019-05-21 |
| 1134644321 | Bridgette Hennigsen | Social Worker | 3810 Se 11th Ave, Portland, OR 97202 | 2017-08-08 |
| 1558895789 | Lenore Cangeloso | Acupuncturist | 1235 Se Division Street, Suie 117, Portland, OR 97202 | 2017-04-14 |
| 1376099093 | Anna Christine Leclerc | Contractor | 2024 Se Clinton Street, Zenana Spa and Wellness Center, Portland, OR 97202 | 2016-09-01 |
| 1144684663 | Catholic Charities | Case Management | 2740 Se Powell Blvd., Portland, OR 97202 | 2016-04-11 |
| 1881082097 | Zoomcare Dental, P.C. | Dentist | 3130 Se Division Street, Building 2, Portland, OR 97202 | 2014-12-23 |
| 1124424700 | Jessica Nash | Counselor | 6411 Se 17th Ave, Portland, OR 97202 | 2014-11-10 |
| Find all providers in zip 97202 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588178701 | Daniel Hendrickson | Pharmacist | 503 Sw 5th Avenue, Portland, OR 97204 | 2017-11-27 |
| 1336662204 | Jenny French | Pharmacist | 9427 Sw Barnes Rd Ste 295, Portland, OR 97225-6652 | 2017-07-21 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1245695956 | M. Katherine Welch | Pharmacist | 3228 Sw Water Ave, Portland, OR 97239-4632 | 2015-12-22 |
| 1790176006 | Jacob Tang | Pharmacist | 1940 Se 12th Ave Apt 9, Portland, OR 97214-4779 | 2015-02-09 |
| 1902211196 | Danit Chetron | Pharmacist | 2323 Sw Caldew St, Portland, OR 97219-2618 | 2014-06-25 |
| 1023350881 | Joey Goren Degrood | Pharmacist | 9044 Sw Rystadt Ln, Portland, OR 97225-2851 | 2013-03-20 |
| 1831435213 | James L Huang | Pharmacist | 300 N Graham St Ste 200, Portland, OR 97227 | 2012-12-12 |
| 1972853331 | Sharon Leigh | Pharmacist | 4531 Se Belmont St. Suite 100, Portland, OR 97215-1675 | 2012-09-13 |
| 1649544107 | Ryan Bradley | Pharmacist | 6348 Ne Halsey St Ste A, Portland, OR 97213-4720 | 2012-03-01 |
| 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.