Healthcare Provider Details

I. General information

NPI: 1164780532
Provider Name (Legal Business Name): UNIVERSITY COMPOUNDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 SW PIONEER CT
WILSONVILLE OR
97070-9623
US

IV. Provider business mailing address

9150 SW PIONEER CT
WILSONVILLE OR
97070-9623
US

V. Phone/Fax

Practice location:
  • Phone: 503-427-0361
  • Fax: 971-224-4385
Mailing address:
  • Phone: 503-427-0361
  • Fax: 971-224-4385

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 TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberRP-0002240-CS
License Number StateOR

VIII. Authorized Official

Name: TERESA YIP
Title or Position: MANAGER
Credential:
Phone: 503-427-0361