# PORTLAND PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PORTLAND PHARMACY INC LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588495659
- **Authorized official:** MALIK AHMED SHAIBI (SUPERVISING PHARMACY)
- **Authorized official phone:** (313) 442-2400

## Contact information

- **Practice address:** 1295 PORTLAND AVE STE 2, ROCHESTER, NY 14621-2726
- **Practice address phone:** (585) 537-7081
- **Practice address fax:** (585) 568-7909
- **Mailing address:** 1295 PORTLAND AVE STE 2, ROCHESTER, NY 14621-2726
- **Mailing address phone:** (585) 537-7081
- **Mailing address fax:** (585) 568-7909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/12/2024
- **Last updated:** 08/12/2024