# ISSE PHARMACY SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225464118
- **Authorized official:** DR. JARED ISSE PHARMD (OWNER/PHARMACIST)
- **Authorized official phone:** (503) 908-0630

## Contact information

- **Practice address:** 15635 SE 114TH AVE STE 101, CLACKAMAS, OR 97015-9028
- **Practice address phone:** (503) 908-0630
- **Practice address fax:** (503) 908-0865
- **Mailing address:** 15635 SE 114TH AVE STE 101, CLACKAMAS, OR 97015-9028
- **Mailing address phone:** (503) 908-0630
- **Mailing address fax:** (503) 908-0865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | RP-0002831 | OR | Yes |

## Other

- **Enumeration date:** 09/24/2013
- **Last updated:** 03/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2142223 | PK | — |
| 05 | — | 500667941 | — | OR |