MS. MARYLOU WACEK (NPI# 1336408616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336408616 |
| Entity Type | Individual |
| Full Name | MS. MARYLOU WACEK |
| Practice Address |
4849 Ne 138th Ave Portland OR 97230-3401 |
| Practice Telephone | 5032573935 |
| Practice Fax Number | 5032533747 |
| Mailing Telephone | 5032573935 |
| Mailing Fax Number | 5032573935 |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2015-12-31 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 4981 | OR | Pharmacy Service Providers |
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
4981 | OR | Pharmacy Service Providers |
| Street Address |
4849 NE 138TH AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230-3401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306956933 | Costco Wholesale Corporation | Pharmacy | 4849 Ne 138th Ave, Portland, OR 97230 | 2006-08-30 |
| 1194291591 | Henry Marin | Pharmacist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2018-10-23 |
| 1215392642 | Charles Steve Byars | Pharmacist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2015-12-30 |
| 1376936310 | Costco Wholesale Corporation | Hearing Aid Equipment | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2015-03-16 |
| 1871983411 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2015-02-04 |
| 1437432226 | Catherine Altermatt Ward | Pharmacist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2011-09-28 |
| 1851674741 | Annie Nhu Le | Pharmacist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2011-09-27 |
| 1366724551 | Jeffrey Mangum | Pharmacist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2011-09-13 |
| 1295947745 | Steven Dean Porter | Optometrist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2007-05-04 |
| 1750410734 | Uyen Tram Dinh | Optometrist | 4849 Ne 138th Ave, Portland, OR 97230-3401 | 2007-03-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| 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.