MEDICARE: PEGGY L NELSON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	9243	OR
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	9243	OR

General Provider Information

NPI Number	:	1205835733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY L NELSON RPH

Provider Business Mailing Address
First Line	:	4137 NE 132ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-1428
Country	:	US
Telephone Number	:	541-951-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	3957 N HAMPTON CT
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-3781
Country	:	US
Telephone Number	:	503-975-5589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	12/29/2015

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