Healthcare Provider Details

I. General information

NPI: 1114164381
Provider Name (Legal Business Name): OREGON HEALTH & SCIENCE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 SW GREYSTONE CT
BEAVERTON OR
97006-6011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD MAIL CODE: CR 9-4
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 971-262-9110
  • Fax: 971-262-9364
Mailing address:
  • Phone: 503-494-8007
  • Fax: 503-494-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRP-0002504-CS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberRP-0002504-CS
License Number StateOR

VIII. Authorized Official

Name: KELLY ANNE SMITH
Title or Position: VICE PRESIDENT, ERC
Credential:
Phone: 503-494-8007