MEDICARE: ZOOM CARE PC

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	RP002901CS	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2148557	OTHER		PK

General Provider Information

NPI Number	:	1972908077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZOOM CARE PC

Provider Business Mailing Address
First Line	:	1455 NW IRVING ST
Second Line	:	SUITE 500
City	:	PORTLAND
State	:	OR
Zip	:	97209-2274
Country	:	US
Telephone Number	:	503-941-3807
Fax Number	:	503-941-3809

Provider Business Practice Location Address
First Line	:	1455 NW IRVING ST STE 500
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2277
Country	:	US
Telephone Number	:	503-941-3807
Fax Number	:	503-941-3809

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY / PIC
Name	:	LARRY CARTIER
Credential	:	RPH
Telephone Number	:	503-941-3807

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	12/08/2016

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Directions to “ZOOM CARE PC ” Practice Location

Language	Start Address	Practice Location

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