DR. TRACI MO (NPI# 1467995886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467995886 |
| Entity Type | Individual |
| Full Name | DR. TRACI MO |
| Credential | PHARM.D. |
| Practice Address |
24800 Se Stark St Gresham OR 97030-3378 |
| Practice Telephone | 5036741339 |
| Mailing Telephone | 5036741339 |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | PH60570573 | WA | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | RPH-0015754 | OR | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WASHINGTON BOARD OF PHARMACY | PH60570573 | 01 |
| OR | OREGON BOARD OF PHARMACY | RPH-0015754 | 01 |
| Street Address |
24800 SE STARK ST |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3378 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033183918 | Amy Katherine Chaumeton | Internal Medicine | 24800 Se Stark St, Gresham, OR 97030-3378 | 2006-02-15 |
| 1154984763 | Devon Heisler | Pharmacy | 24800 Se Stark St, Gresham, OR 97030-3378 | 2019-04-18 |
| 1356806970 | Tyrell Anthony Comeaux | Dietitian, Registered | 24800 Se Stark St, Gresham, OR 97030-3378 | 2019-02-07 |
| 1710490156 | Kathryn Collins | Physical Therapist | 24800 Se Stark St, Gresham, OR 97030-3378 | 2017-11-08 |
| 1437604279 | Leslie Hoang | Physical Therapist | 24800 Se Stark St, Gresham, OR 97030-3378 | 2016-08-22 |
| 1477926574 | Korina Leclerc | Social Worker | 24800 Se Stark St, Gresham, OR 97030-3378 | 2015-11-11 |
| 1326414202 | Mike (huy) Minh Nguyen | Pharmacist | 24800 Se Stark St, Gresham, OR 97030-3378 | 2015-08-14 |
| 1760878243 | Matthew Sabongi | Internal Medicine | 24800 Se Stark St, Gresham, OR 97030-3378 | 2015-04-10 |
| 1922406362 | Rnfa Assist, LLC | Registered Nurse | 24800 Se Stark St, Gresham, OR 97030-3378 | 2014-12-17 |
| 1285039974 | Jane Sayner | Dietitian, Registered | 24800 Se Stark St, Gresham, OR 97030-3378 | 2014-10-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841643681 | Laura Pahlmeyer | Pharmacist | 24988 Se Stark St Ste 220, Gresham, OR 97030-8324 | 2016-07-17 |
| 1992061048 | Russell A Wendt | Pharmacist | 2497 Ne Roberts Ave, Gresham, OR 97080 | 2012-04-03 |
| 1801160684 | William Robert Dupuis | Pharmacist | 2800 Ne Hogan Dr, Gresham, OR 97030-3100 | 2012-02-27 |
| 1326352030 | Jeffery Bradford Yates | Pharmacist | 1555 Ne Division St, Gresham, OR 97030-4271 | 2010-08-05 |
| 1497084453 | Katherine Cheng | Pharmacist | 439 Se 223rd Ave, Gresham, OR 97030 | 2009-12-21 |
| 1356595821 | Jeffrey Robert Nikolaisen | Pharmacist | 439 Southeast 223rd Avenue, Gresham, OR 97030 | 2008-11-11 |
| 1932223880 | Julie Elizabeth Croshaw | Pharmacist | 2444 E Powell Blvd, Gresham, OR 97080 | 2007-03-18 |
| 1386255156 | Crystal Jihyun Rim | Pharmacist | 24988 Se Stark St Ste 220, Gresham, OR 97030-8324 | 2020-08-13 |
| 1093227548 | Tatyana Shiyenkova | Pharmacist | 1555 Ne Division St, Gresham, OR 97030-4271 | 2017-10-24 |
| 1174068126 | Justin Ngo | Pharmacist | 4285 W Powell Blvd, Gresham, OR 97030-5050 | 2016-12-29 |
| Find all providers in GRESHAM | ||||
Please comment or provide details below to improve the information on DR. TRACI MO.
| 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.