Healthcare Provider Details

I. General information

NPI: 1841005428
Provider Name (Legal Business Name): MIKA MICHAELS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 NE 2ND AVE
PORTLAND OR
97232-2003
US

IV. Provider business mailing address

1225 NE 2ND AVE
PORTLAND OR
97232-2003
US

V. Phone/Fax

Practice location:
  • Phone: 503-944-7702
  • Fax:
Mailing address:
  • Phone: 503-944-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0202209415
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRPH-0014816
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: