MEDICARE: DR. KENITH CHARELS FRITSCHE PHARM.D.

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	RPH-0014951	OR
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0014951	OR
3	183500000X	Pharmacist	PH60620587	WA

General Provider Information

NPI Number	:	1578931895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENITH CHARELS FRITSCHE PHARM.D.

Provider Business Mailing Address
First Line	:	21500 NE HALSEY ST
Second Line	:
City	:	FAIRVIEW
State	:	OR
Zip	:	97024-8616
Country	:	US
Telephone Number	:	503-491-8953
Fax Number	:	503-405-9817

Provider Business Practice Location Address
First Line	:	514 NE 181ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-6702
Country	:	US
Telephone Number	:	503-661-6991
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	11/20/2020

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