=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982153789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NETTI SEGA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2016
-----------------------------------------------------
Last Update Date | 01/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4246 NE SANDY BLVD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97213-1432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-287-1163
-----------------------------------------------------
Fax | 503-282-2281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4246 NE SANDY BLVD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97213-1432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-287-1163
-----------------------------------------------------
Fax | 503-282-2281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 0014928
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 33247
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 0014928
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------