Healthcare Provider Details

I. General information

NPI: 1225514375
Provider Name (Legal Business Name): DANE M FICKES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S CENTRAL AVE STE 101G
MEDFORD OR
97501-7808
US

IV. Provider business mailing address

724 S CENTRAL AVE STE 101G
MEDFORD OR
97501-7808
US

V. Phone/Fax

Practice location:
  • Phone: 541-329-0478
  • Fax: 541-314-9556
Mailing address:
  • Phone: 541-329-0478
  • Fax: 541-314-9556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0016659
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: