Organization
MULTNOMAH COUNTY
Active
Other names
NORTHEAST HEALTH CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE KODER (PHARMACY DIRECTOR)
(503) 988-7278
Entity
Organization
Contact information
Practice address
5329 NE MARTIN L KING FL JRBLVD2, PORTLAND, OR 97211-3237
(503) 988-3634
(503) 988-4345
Mailing address
619 NW 6TH AVE FL 7, PORTLAND, OR 97209-3964
(503) 988-3634
(503) 988-4345
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RP-0000961-CS
OR
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136424
—
OR
01
—
2078364
PK
—
Enumeration date
07/30/2006
Last updated
11/08/2019
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