Organization
PHARMBLUE OREGON LLC
Active
Other names
PharmBlue Oregon LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NELSON (CEO)
(724) 779-4720
Entity
Organization
Contact information
Practice address
140 S HOLLY ST, SUITE 1131, MEDFORD, OR 97501-3113
(800) 967-6816
(855) 570-4895
Mailing address
40 PENNWOOD PL, SUITE 300, WARRENDALE, PA 15086-6526
(724) 779-4720
(724) 779-4721
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
RP-0003221-CS
OR
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811349434
—
OR
01
—
2160991
PK
—
Enumeration date
07/07/2016
Last updated
03/23/2017
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