Organization
PORTLAND PROFESSIONAL PHARMACY, LLC
Active
Other names
Portland Professional Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN HODGE (MANAGER)
(702) 203-4797
Entity
Organization
Contact information
Practice address
11717 NE GLISAN ST, PORTLAND, OR 97220-2141
(971) 200-8324
Mailing address
11717 NE GLISAN ST, PORTLAND, OR 97220-2141
(702) 203-4797
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP-0003101-CS
OR
Other
Enumeration date
07/09/2015
Last updated
08/04/2015
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