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Organization
POWELL PHARMACY, LLC
Active
Organization
POWELL PHARMACY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY DONTSOV (MANAGING MEMBER)
(818) 687-7368
Entity
Organization
Contact information
Practice address
11050 SE POWELL BLVD STE 375, PORTLAND, OR 97266-1863
(818) 687-7368
Mailing address
11050 SE POWELL BLVD STE 375, PORTLAND, OR 97266-1863
(818) 687-7368
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0002838CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0002838CS
PHARMACY LICENSE
OR
Enumeration date
11/04/2013
Last updated
11/04/2013
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