Organization
COMMUNITY COMPOUNDING PHARMACY
Active
Other names
COMMUNITY COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE ROSENBERG RPH (OWNER)
(503) 303-7373
Entity
Organization
Contact information
Practice address
6025 JEAN RD, LAKE OSWEGO, OR 97035-5307
(503) 303-7373
(503) 344-4996
Mailing address
6025 JEAN RD, LAKE OSWEGO, OR 97035-5307
(503) 303-7373
(503) 344-4996
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
RP0002481CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079590
PK
—
Enumeration date
06/27/2008
Last updated
04/18/2017
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