Provider Demographics
NPI:1619243425
Name:MAI, RICK
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:MAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-5400
Mailing Address - Country:US
Mailing Address - Phone:503-537-1383
Mailing Address - Fax:
Practice Address - Street 1:3300 PORTLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-5400
Practice Address - Country:US
Practice Address - Phone:503-537-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010517183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist