Healthcare Provider Details

I. General information

NPI: 1255605176
Provider Name (Legal Business Name): MICHAEL WAYNE RICKMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SE COURT AVE
PENDLETON OR
97801-3217
US

IV. Provider business mailing address

1601 SE COURT AVE
PENDLETON OR
97801-3217
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-3234
  • Fax: 542-278-2626
Mailing address:
  • Phone: 541-278-3234
  • Fax: 542-278-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0009407
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: