Organization
GRESHAM PROFESSIONAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID G MOLL PHARMD (CEO)
(503) 491-0117
Entity
Organization
Contact information
Practice address
24076 SE STARK ST, SUITE 100, GRESHAM, OR 97030-3373
(503) 491-0117
(503) 489-2078
Mailing address
24076 SE STARK ST, SUITE 100, GRESHAM, OR 97030-3373
(503) 491-0117
(503) 489-2078
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
8305
OR
3336C0003X
Community/Retail Pharmacy
Primary
002102
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299911
—
OR
01
—
3815125
NABP/NCPDP #
OR
Enumeration date
10/20/2005
Last updated
10/21/2008
Update your record
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