Organization
MAPLE STREET CLINIC PHARMACY LLC
Active
Other names
MAPLE STREET CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER VORRATH PHRM (PRES)
(503) 357-7552
Entity
Organization
Contact information
Practice address
1825 MAPLE ST, FOREST GROVE, OR 97116-1939
(503) 357-7552
(503) 359-5071
Mailing address
1825 MAPLE ST, FOREST GROVE, OR 97116-1939
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
RP0000674CS
OR
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0003280
—
OR
01
—
3810163
OTHER ID NUMBER
—
Enumeration date
01/03/2007
Last updated
06/23/2008
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