Basic Information
| Provider Information | |||||||||
| NPI: | 1669757936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIX | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | KERNS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 CENTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973012669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039452945 | ||||||||
| FaxNumber: | 5039451085 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 CENTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973012669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039452945 | ||||||||
| FaxNumber: | 5039451085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2011 | ||||||||
| LastUpdateDate: | 10/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH-0009893 | OR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.