Healthcare Provider Details

I. General information

NPI: 1881700862
Provider Name (Legal Business Name): MELINDA M BUTLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA M HERMES RPH

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 SW 13TH AVE
PORTLAND OR
97205-1703
US

IV. Provider business mailing address

1132 SW 13TH AVE
PORTLAND OR
97205-1703
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-3888
  • Fax: 503-961-8241
Mailing address:
  • Phone: 503-535-3888
  • Fax: 503-961-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9034
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9034
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: