Provider Demographics
NPI:1598753774
Name:WHEELER, RICHARD M (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:WHEELER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4168
Mailing Address - Country:US
Mailing Address - Phone:503-254-7383
Mailing Address - Fax:503-254-4568
Practice Address - Street 1:149 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4168
Practice Address - Country:US
Practice Address - Phone:503-254-7383
Practice Address - Fax:503-254-4568
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR170080Medicaid