Healthcare Provider Details

I. General information

NPI: 1679183578
Provider Name (Legal Business Name): PEACEHEALTH NETWORKS ON DEMAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24118 BOTHELL EVERETT HWY UNIT 200
BOTHELL WA
98021-9379
US

IV. Provider business mailing address

11958 SW GARDEN PL
TIGARD OR
97223-8248
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-8252
  • Fax: 833-450-6410
Mailing address:
  • Phone: 503-684-8252
  • Fax: 866-859-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MALLORY ALYSE KEMPTON-HEIN
Title or Position: PHARMACIST
Credential: PHARM D.
Phone: 503-684-8252