# PROVIDENCE HEALTH & SERVICE - OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Portland Medical Center Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386034312
- **Authorized official:** TAVIS SMITH (OPERATIONS MANAGER)
- **Authorized official phone:** (503) 215-6296

## Contact information

- **Practice address:** 4805 NE GLISAN ST, PORTLAND, OR 97213-2933
- **Practice address phone:** (503) 215-6080
- **Mailing address:** 4805 NE GLISAN ST, PORTLAND, OR 97213-2933
- **Mailing address phone:** (503) 215-6080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0000780 | OR | Yes |

## Other

- **Enumeration date:** 01/29/2015
- **Last updated:** 01/29/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2149074 | PK | — |