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General NPI Number Information
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NPI Number | 1164240040
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Entity Type | Individual
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Provider Name | MICAELA HERSH
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 873 NW OAK AVE
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City | CORVALLIS
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State | OR
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Zip | 97330-1518
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Country | US
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Telephone | 360-608-2791
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Fax |
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Provider Business Mailing Address
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Address Line | 7731 E NORTHERN LIGHTS BLVD
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City | ANCHORAGE
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State | AK
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Zip | 99504-3572
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Country | US
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Telephone | 907-339-1760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PI-0014100
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License Number State | OR
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