Healthcare Provider Details

I. General information

NPI: 1295652493
Provider Name (Legal Business Name): FRANK ANTHONY MISTRETTA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24988 SE STARK ST BLDG 3
GRESHAM OR
97030-8322
US

IV. Provider business mailing address

3303 S BOND AVE RM 12270
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 971-262-9053
  • Fax:
Mailing address:
  • Phone: 971-262-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0014016
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: