Organization
PACIFIC COMPOUNDS PHARMACY LLC
Active
Other names
Pacific Compounds Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM GUSTAFSON (MANAGER)
(503) 640-3080
Entity
Organization
Contact information
Practice address
327 SE 3RD AVE, HILLSBORO, OR 97123-4001
(503) 640-3080
(503) 640-3208
Mailing address
327 SE 3RD AVE, HILLSBORO, OR 97123-4001
(503) 640-3080
(503) 640-3208
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
RP-0001904-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3814402
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/03/2007
Last updated
12/02/2009
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