Organization
MOUNTAIN PARK PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE BLEAKMAN RPH (OWNER)
(503) 636-1243
Entity
Organization
Contact information
Practice address
3 MONROE PKWY STE O, LAKE OSWEGO, OR 97035-8874
(503) 636-1243
(503) 636-0925
Mailing address
3 MONROE PKWY STE O, LAKE OSWEGO, OR 97035-8874
(503) 636-1243
(503) 636-0925
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1270
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052113
—
OR
Enumeration date
03/17/2007
Last updated
08/22/2020
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