Individual
KIM D WHEELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1125 NE 99TH AVE, PORTLAND, OR 97220-9428
(503) 254-7383
(503) 254-4568
Mailing address
742 NE 236TH PL, WOOD VILLAGE, OR 97060-2768
(503) 254-7383
(503) 254-4568
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0006537
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0006537
PHARMACIST LICENSE
OR
01
—
RPH-0006537-P
PHARMACY PRECEPTOR LICENSE
OR
Enumeration date
03/22/2013
Last updated
03/22/2013
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