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Organization
PORTLAND PROFESSIONAL PHARMACY, LLC
Active
Organization
PORTLAND PROFESSIONAL PHARMACY, LLC
Active
Other names
Portland Professional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN HODGE (MANAGER)
(702) 203-4797
Entity
Organization
Contact information
Practice address
11717 NE GLISAN ST, PORTLAND, OR 97220-2141
(971) 200-8324
Mailing address
11717 NE GLISAN ST, PORTLAND, OR 97220-2141
(702) 203-4797
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP-0003101-CS
OR
Other
Enumeration date
07/09/2015
Last updated
08/04/2015
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