Healthcare Provider Details

I. General information

NPI: 1982772786
Provider Name (Legal Business Name): HOLLYWOOD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 CAPITOL ST NE
SALEM OR
97301-7859
US

IV. Provider business mailing address

1890 CAPITOL ST NE
SALEM OR
97301-7859
US

V. Phone/Fax

Practice location:
  • Phone: 503-364-4436
  • Fax: 503-364-5103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00526
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KASPRZYK
Title or Position: OWNER
Credential: RPH
Phone: 503-364-4436