Healthcare Provider Details

I. General information

NPI: 1528073327
Provider Name (Legal Business Name): MULTNOMAH COUNTY OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 NW 6TH AVE FL 1
PORTLAND OR
97209-3964
US

IV. Provider business mailing address

619 NW 6TH AVE FL 7
PORTLAND OR
97209-3964
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-5267
  • Fax: 503-988-5781
Mailing address:
  • Phone: 503-988-5267
  • Fax: 503-988-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRP-0000960-CS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHELE KODER
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 503-988-7278