# PHARMBLUE OREGON LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PharmBlue Oregon LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811349434
- **Authorized official:** MICHAEL NELSON (CEO)
- **Authorized official phone:** (724) 779-4720

## Contact information

- **Practice address:** 140 S HOLLY ST, SUITE 1131, MEDFORD, OR 97501-3113
- **Practice address phone:** (800) 967-6816
- **Practice address fax:** (855) 570-4895
- **Mailing address:** 40 PENNWOOD PL, SUITE 300, WARRENDALE, PA 15086-6526
- **Mailing address phone:** (724) 779-4720
- **Mailing address fax:** (724) 779-4721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | RP-0003221-CS | OR | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/07/2016
- **Last updated:** 03/23/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1811349434 | — | OR |
| 01 | — | 2160991 | PK | — |