Unknown Individual – Pharmacist, NPI 1053415208

Unknown Individual is a healthcare provider. based in Portland, Oregon. specializing in Pharmacist. They hold a License No. 8732 (OR). The NPI Number for Unknown Individual is 1053415208

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1053415208
Phone
(503) 731-8682
Address
1121 NE 2ND AVE
Deactivation Date
19 July 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1121, Northeast 2nd Avenue, Lloyd District, Portland, Metro, Multnomah County, Oregon, 97232, United States

    OREGON STATE HOSPITAL PORTLAND

    PORTLAND, OR 97232

    Phone: (503) 731-8682

    Type: Location

  • PO BOX 14900

    STATE OF OREGON OREGON STATE HOSPITAL ITRS UNIT

    SALEM, OR 973095016

    Phone: (503) 945-9840

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97232)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1053415208.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Pharmacist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Portland, Oregon; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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