Provider Demographics
NPI:1114393006
Name:VECCHIO-MILLER, CAELON ADAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAELON
Middle Name:ADAM
Last Name:VECCHIO-MILLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:CAELON
Other - Middle Name:
Other - Last Name:VECCHIO-MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4885 ASTER ST
Mailing Address - Street 2:#119
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6695
Mailing Address - Country:US
Mailing Address - Phone:406-396-7095
Mailing Address - Fax:
Practice Address - Street 1:3521 NW SAMARITAN DR STE 202
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4744
Practice Address - Country:US
Practice Address - Phone:541-768-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0014797183500000X
OR147971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist