Organization
HOLLYWOOD PHARMACY INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT KASPRZYK RPH (OWNER)
(503) 364-4436
Entity
Organization
Contact information
Practice address
1890 CAPITOL ST NE, SALEM, OR 97301-7859
(503) 364-4436
(503) 364-5103
Mailing address
1890 CAPITOL ST NE, SALEM, OR 97301-7859
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00526
OR
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131177
—
OR
05
—
230545
—
OR
01
—
292935
MEDICAID DME
OR
01
—
3804627
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
12/01/2006
Last updated
03/07/2023
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