Healthcare Provider Details

I. General information

NPI: 1336108711
Provider Name (Legal Business Name): INDEPENDENCE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 MONMOUTH ST
INDEPENDENCE OR
97351-1126
US

IV. Provider business mailing address

916 W EVERGREEN BLVD
VANCOUVER WA
98660-3035
US

V. Phone/Fax

Practice location:
  • Phone: 503-838-2195
  • Fax: 503-838-3129
Mailing address:
  • Phone: 360-213-2236
  • Fax: 360-213-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRP0000952CS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTI VEIS
Title or Position: VP OF PHARMACY
Credential:
Phone: 503-507-6073