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Organization
PROFESSIONAL 205 PHARMACY
Active
Organization
PROFESSIONAL 205 PHARMACY
Active
Other names
Professional Center 205 Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HODGE (OWNER)
(503) 255-2546
Entity
Organization
Contact information
Practice address
10000 SE MAIN ST STE 118, PORTLAND, OR 97216-2462
(503) 255-2546
(503) 255-3893
Mailing address
10000 SE MAIN ST STE 118, PORTLAND, OR 97216-2462
(503) 255-2546
(503) 255-3893
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP,0000689
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160623
PK
—
Enumeration date
07/08/2016
Last updated
08/17/2016
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