Organization
WILLAMETTE PAIN & SPINE CENTER PC
Active
Other names
Sunnyside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMIE MISKIMINS (MGR, LICENSING & THIRD PARTY)
(817) 572-0009
Entity
Organization
Contact information
Practice address
10001 SE SUNNYSIDE RD STE 100A, CLACKAMAS, OR 97015-9728
(503) 343-9363
Mailing address
1620 W. NORTHWEST HWY, STE. 100, GRAPEVINE, TX 76051
(817) 572-0009
(817) 720-1039
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0003062CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2151143
PK
—
Enumeration date
04/03/2015
Last updated
06/29/2016
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