# MOUNTAIN PARK PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669596508
- **Authorized official:** JULIE BLEAKMAN RPH (OWNER)
- **Authorized official phone:** (503) 636-1243

## Contact information

- **Practice address:** 3 MONROE PKWY STE O, LAKE OSWEGO, OR 97035-8874
- **Practice address phone:** (503) 636-1243
- **Practice address fax:** (503) 636-0925
- **Mailing address:** 3 MONROE PKWY STE O, LAKE OSWEGO, OR 97035-8874
- **Mailing address phone:** (503) 636-1243
- **Mailing address fax:** (503) 636-0925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 1270 | OR | Yes |

## Other

- **Enumeration date:** 03/17/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 052113 | — | OR |