Organization
PORTLAND COMPOUNDING PHARMACY LLC
Active
Other names
Lloyd Center Pharmacy, Lloyd Central Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NATALIE GUSTAFSON PHARMD (DIRECTOR OF PHARMACY)
(503) 281-4161
Entity
Organization
Contact information
Practice address
2606 NE BROADWAY ST STE B, PORTLAND, OR 97232-1898
(503) 281-4161
(503) 281-1990
Mailing address
2606 NE BROADWAY ST STE B, PORTLAND, OR 97232-1898
(503) 281-4161
(503) 281-1990
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
RP-0000465-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134247
PK
—
Enumeration date
08/13/2006
Last updated
11/15/2018
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