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General NPI Number Information
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NPI Number | 1336223171
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES - OREGON
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 6410 NE HALSEY ST SUITE 400
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City | PORTLAND
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State | OR
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Zip | 97213-4742
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Country | US
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Telephone | 503-215-4633
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Fax | 503-215-0576
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Provider Business Mailing Address
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Address Line | PO BOX 5936B
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City | PORTLAND
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State | OR
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Zip | 97228-5936
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Country | US
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Telephone | 503-215-5033
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Fax | 503-215-0542
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Authorized Official
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Title or Position | ASSISTANT SECRETARY ENROLLMENTS
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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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 | IP0001899-CS
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License Number State | OR
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