# POWELL PHARMACY, LLC

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

## Provider details

- **NPI number:** 1699104372
- **Authorized official:** GARY DONTSOV (MANAGING MEMBER)
- **Authorized official phone:** (818) 687-7368

## Contact information

- **Practice address:** 11050 SE POWELL BLVD STE 375, PORTLAND, OR 97266-1863
- **Practice address phone:** (818) 687-7368
- **Mailing address:** 11050 SE POWELL BLVD STE 375, PORTLAND, OR 97266-1863
- **Mailing address phone:** (818) 687-7368

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP0002838CS | OR | Yes |

## Other

- **Enumeration date:** 11/04/2013
- **Last updated:** 11/04/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | RP0002838CS | PHARMACY LICENSE | OR |