Organization
MULTNOMAH COUNTY OREGON
Active
Other names
Southeast Health Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE KODER (PHARMACY DIRECTOR)
(503) 988-7278
Entity
Organization
Contact information
Practice address
3653 SE 34TH AVE, PORTLAND, OR 97202-3034
(503) 988-5423
(503) 988-4345
Mailing address
619 NW 6TH AVE FL 7, PORTLAND, OR 97209-3964
(503) 988-5423
(503) 988-4345
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
RP-0002772-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123620
—
OR
01
—
3844621
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/25/2013
Last updated
11/08/2019
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