Healthcare Provider Details

I. General information

NPI: 1215247200
Provider Name (Legal Business Name): ANNIE RATLIFF CAPELLE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SW 72ND AVE
TIGARD OR
97224-7745
US

IV. Provider business mailing address

11483 SW 90TH AVE
TIGARD OR
97223-6406
US

V. Phone/Fax

Practice location:
  • Phone: 503-626-9436
  • Fax: 503-372-1792
Mailing address:
  • Phone: 541-231-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH-0011897
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: