# LEGACY MERIDAN PARK HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Meridian Park Medical Center Community Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497170849
- **Authorized official:** MICHAEL SIEG RPH (PHCY SRVCS MGR)
- **Authorized official phone:** (503) 692-2665

## Contact information

- **Practice address:** 19300 SW 65TH AVE, TUALATIN, OR 97062-7706
- **Practice address phone:** (503) 692-7470
- **Practice address fax:** (503) 692-7437
- **Mailing address:** 19300 SW 65TH AVE, TUALATIN, OR 97062-7706
- **Mailing address phone:** (503) 692-2454
- **Mailing address fax:** (503) 692-7437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP-0000864 | OR | Yes |

## Other

- **Enumeration date:** 02/21/2014
- **Last updated:** 03/09/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2144384 | PK | — |