# PROVIDENCE HEALTH & SERVICES - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES - OREGON
- **Other names:** Providence Specialty Pharmacy Services-LTC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336223171
- **Legal business name:** PROVIDENCE HEALTH & SERVICES - OREGON
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 6410 NE HALSEY ST, SUITE 400, PORTLAND, OR 97213-4742
- **Practice address phone:** (503) 215-4633
- **Practice address fax:** (503) 215-0576
- **Mailing address:** PO BOX 5936B, PORTLAND, OR 97228-5936
- **Mailing address phone:** (503) 215-5033
- **Mailing address fax:** (503) 215-0542

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | IP0001899-CS | OR | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 05/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 233012 | — | OR |
| 01 | — | 3815315 | NCPDP | — |