Organization
MEDICATION MANAGEMENT PROGRAM
Active
Other names
Medication Management Program
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE LOGAN (DIRECTOR, PHARMACY)
(503) 261-7980
Entity
Organization
Contact information
Practice address
5717 NE 138TH AVE, PORTLAND, OR 97230-3409
(503) 261-7541
(503) 261-2048
Mailing address
5717 NE 138TH AVE, PORTLAND, OR 97230-3409
(503) 261-7541
(503) 261-2048
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
00058657
WA
3336C0002X
Clinic Pharmacy
Primary
2131
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136668
—
OR
01
—
2146486
PK
—
05
—
6019392
—
WA
Enumeration date
06/26/2014
Last updated
06/01/2021
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