Provider Demographics
NPI:1568865111
Name:POKORNY, MEGAN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:POKORNY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:INSERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1562 WALLACE RD NW
Mailing Address - Street 2:133
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2678
Mailing Address - Country:US
Mailing Address - Phone:815-715-2106
Mailing Address - Fax:
Practice Address - Street 1:2855 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305
Practice Address - Country:US
Practice Address - Phone:503-585-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297774183500000X
OR00143141835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist