# ASSURED PHARMACY GRESHAM INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ASSURED PHARMACY GRESHAM
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588741458
- **Authorized official:** JULIETTE JOHNSON (ACCOUNTING ANALYST)
- **Authorized official phone:** (972) 668-7394

## Contact information

- **Practice address:** 831 NW COUNSIL DR, STE 115, GRESHAM, OR 97030
- **Practice address phone:** (971) 223-0552
- **Practice address fax:** (503) 492-2148
- **Mailing address:** 5760 LEGACY DR, STE. B3-518, PLANO, TX 75024-7102
- **Mailing address phone:** (972) 668-7394
- **Mailing address fax:** (866) 232-1680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP0002366 | OR | Yes |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 03/07/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3842590 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |