Individual
EDWARD MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1455 NW IRVING ST STE 500, PORTLAND, OR 97209-2277
(503) 941-3807
Mailing address
9640 SW SHADY PL, TIGARD, OR 97223-1132
(503) 730-3283
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH-0013551
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1835P0018X
—
OR
Enumeration date
08/15/2018
Last updated
08/15/2018
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