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NPI Code Detail

MEDICARE: PEACEHEALTH NETWORKS ON DEMAND, LLC

MEDICARE: PEACEHEALTH NETWORKS ON DEMAND, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing Site

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000067OTHERORDISPENSING PRACTITIONER DRUG OUTLET

General Provider Information

NPI Number : 1306456686
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEACEHEALTH NETWORKS ON DEMAND, LLC
Provider Business Mailing Address
First Line : 11958 SW GARDEN PL
Second Line :
City : TIGARD
State : OR
Zip : 97223-8248
Country : US
Telephone Number : 503-684-8252
Fax Number : 866-859-8195
Provider Business Practice Location Address
First Line : 3060 SE HAWTHORNE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97214-4121
Country : US
Telephone Number : 503-684-8252
Fax Number : 833-450-6699
Authorized Official
Title or Position : PHARMACIST
Name : DR. MALLORY ALYSE KEMPTON-HEIN
Credential : PHARM D.
Telephone Number : 503-684-8252
Provider Enumeration Date : 08/03/2020
Last Update Date : 03/24/2025

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Directions to “PEACEHEALTH NETWORKS ON DEMAND, LLC ” Practice Location

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