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General NPI Number Information
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NPI Number | 1255645271
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Entity Type | Organization
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Legal Business Name | ROCKWOOD HEALTH CLINIC PHARMACY
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 2020 SE 182ND AVE
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City | PORTLAND
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State | OR
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Zip | 97233-5692
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Country | US
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Telephone | 503-988-3353
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Fax | 503-988-4345
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Provider Business Mailing Address
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Address Line | 619 NW 6TH AVE FL 7
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City | PORTLAND
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State | OR
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Zip | 97209-3964
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Country | US
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Telephone | 503-988-3353
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Fax | 503-988-4345
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MICHELE KODER
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Credential |
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Telephone | 503-988-7278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP-0002610-CS
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License Number State | OR
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