Healthcare Provider Details

I. General information

NPI: 1760881791
Provider Name (Legal Business Name): PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 12TH ST PHARMACY
HOOD RIVER OR
97031-1587
US

IV. Provider business mailing address

810 12TH ST
HOOD RIVER OR
97031-1587
US

V. Phone/Fax

Practice location:
  • Phone: 541-387-6338
  • Fax: 541-387-8213
Mailing address:
  • Phone: 541-387-6338
  • Fax: 541-387-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP-0000830-CS
License Number StateOR

VIII. Authorized Official

Name: JENNI R NELSON
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 541-387-8245