Organization
PRESTIGE PROFESSIONAL PHARMACY
Active
Other names
Prestige Professional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CLOSE PHARMACY (OWNER/AO)
(503) 542-0733
Entity
Organization
Contact information
Practice address
11723 NE GLISAN ST, PORTLAND, OR 97220-2141
(866) 660-2626
(888) 299-2770
Mailing address
11723 NE GLISAN ST, PORTLAND, OR 97220-2141
(866) 660-2626
(888) 299-2770
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0003251
OR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167382
PK
—
Enumeration date
01/25/2017
Last updated
02/27/2019
Update your record
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