# PROVIDENCE HEALTH & SERVICES OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Bridgeport Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922330828
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 18040 SW LOWER BOONES FERRY RD STE 104, TIGARD, OR 97224-7259
- **Practice address phone:** (503) 216-0625
- **Practice address fax:** (503) 216-0630
- **Mailing address:** 18040 SW LOWER BOONES FERRY RD, SUITE 104, TIGARD, OR 97224-7258
- **Mailing address phone:** (503) 216-0625
- **Mailing address fax:** (503) 216-0630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP-0002571-CS | OR | Yes |

## Other

- **Enumeration date:** 02/03/2010
- **Last updated:** 07/08/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3843768 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |