# PROFESSIONAL 205 PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Professional Center 205 Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639521149
- **Authorized official:** SUSAN HODGE (OWNER)
- **Authorized official phone:** (503) 255-2546

## Contact information

- **Practice address:** 10000 SE MAIN ST STE 118, PORTLAND, OR 97216-2462
- **Practice address phone:** (503) 255-2546
- **Practice address fax:** (503) 255-3893
- **Mailing address:** 10000 SE MAIN ST STE 118, PORTLAND, OR 97216-2462
- **Mailing address phone:** (503) 255-2546
- **Mailing address fax:** (503) 255-3893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP,0000689 | OR | Yes |

## Other

- **Enumeration date:** 07/08/2016
- **Last updated:** 08/17/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2160623 | PK | — |