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General NPI Number Information
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NPI Number | 1144767427
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Entity Type | Organization
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Legal Business Name | PRESTIGE PROFESSIONAL PHARMACY
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 11723 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97220-2141
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Country | US
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Telephone | 866-660-2626
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Fax | 888-299-2770
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Provider Business Mailing Address
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Address Line | 11723 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97220-2141
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Country | US
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Telephone | 866-660-2626
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Fax | 888-299-2770
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Authorized Official
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Title or Position | OWNER/AO
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Name | CLOSE PHARMACY
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Credential |
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Telephone | 503-542-0733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP0003251
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License Number State | OR
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