# PRESTIGE PROFESSIONAL PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prestige Professional Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144767427
- **Authorized official:** CLOSE PHARMACY (OWNER/AO)
- **Authorized official phone:** (503) 542-0733

## Contact information

- **Practice address:** 11723 NE GLISAN ST, PORTLAND, OR 97220-2141
- **Practice address phone:** (866) 660-2626
- **Practice address fax:** (888) 299-2770
- **Mailing address:** 11723 NE GLISAN ST, PORTLAND, OR 97220-2141
- **Mailing address phone:** (866) 660-2626
- **Mailing address fax:** (888) 299-2770

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP0003251 | OR | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/25/2017
- **Last updated:** 02/27/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2167382 | PK | — |