# PACIFIC COMPOUNDS PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pacific Compounds Pharmacy, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578785119
- **Authorized official:** ADAM GUSTAFSON (MANAGER)
- **Authorized official phone:** (503) 640-3080

## Contact information

- **Practice address:** 327 SE 3RD AVE, HILLSBORO, OR 97123-4001
- **Practice address phone:** (503) 640-3080
- **Practice address fax:** (503) 640-3208
- **Mailing address:** 327 SE 3RD AVE, HILLSBORO, OR 97123-4001
- **Mailing address phone:** (503) 640-3080
- **Mailing address fax:** (503) 640-3208

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | RP-0001904-CS | OR | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 12/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3814402 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |