Provider Demographics
NPI:1912109943
Name:DEERING, NICOLLE KING (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:KING
Last Name:DEERING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20605 SW PRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9701
Mailing Address - Country:US
Mailing Address - Phone:503-358-2962
Mailing Address - Fax:
Practice Address - Street 1:20605 SW PRINDLE RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9701
Practice Address - Country:US
Practice Address - Phone:503-358-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR85981835G0303X
WA200171835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric