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Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - OREGON
Other names
Providence Specialty Pharmacy Services-LTC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - OREGON
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
6410 NE HALSEY ST, SUITE 400, PORTLAND, OR 97213-4742
(503) 215-4633
(503) 215-0576
Mailing address
PO BOX 5936B, PORTLAND, OR 97228-5936
(503) 215-5033
(503) 215-0542
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
IP0001899-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233012
—
OR
01
—
3815315
NCPDP
—
Enumeration date
10/25/2006
Last updated
05/16/2025
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