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Organization
PACIFIC COMPOUNDS PHARMACY LLC
Active
Organization
PACIFIC COMPOUNDS PHARMACY LLC
Active
Other names
Pacific Compounds Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM GUSTAFSON (MANAGER)
(503) 640-3080
Entity
Organization
Contact information
Practice address
327 SE 3RD AVE, HILLSBORO, OR 97123-4001
(503) 640-3080
(503) 640-3208
Mailing address
327 SE 3RD AVE, HILLSBORO, OR 97123-4001
(503) 640-3080
(503) 640-3208
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
RP-0001904-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3814402
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/03/2007
Last updated
12/02/2009
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