Organization
PROVIDENCE HEALTH & SERVICE - OREGON
Active
Other names
Providence Portland Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TAVIS SMITH (OPERATIONS MANAGER)
(503) 215-6296
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-6080
Mailing address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-6080
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0000780
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149074
PK
—
Enumeration date
01/29/2015
Last updated
01/29/2015
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