Provider Demographics
NPI:1578931895
Name:FRITSCHE, KENITH CHARELS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENITH
Middle Name:CHARELS
Last Name:FRITSCHE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21500 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-8616
Mailing Address - Country:US
Mailing Address - Phone:503-491-8953
Mailing Address - Fax:503-405-9817
Practice Address - Street 1:514 NE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6702
Practice Address - Country:US
Practice Address - Phone:503-661-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014951183500000X
OR00149511835P0018X
WAPH60620587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist