Healthcare Provider Details

I. General information

NPI: 1972908077
Provider Name (Legal Business Name): ZOOM CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW IRVING ST STE 500
PORTLAND OR
97209-2277
US

IV. Provider business mailing address

1455 NW IRVING ST SUITE 500
PORTLAND OR
97209-2274
US

V. Phone/Fax

Practice location:
  • Phone: 503-941-3807
  • Fax: 503-941-3809
Mailing address:
  • Phone: 503-941-3807
  • Fax: 503-941-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP002901CS
License Number StateOR

VIII. Authorized Official

Name: LARRY CARTIER
Title or Position: DIRECTOR OF PHARMACY / PIC
Credential: RPH
Phone: 503-941-3807