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General NPI Number Information
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NPI Number | 1396087631
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Entity Type | Organization
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Legal Business Name | MULTNOMAH COUNTY OREGON
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Dates
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Enumeration Date | 03/25/2013
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 3653 SE 34TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-3034
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Country | US
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Telephone | 503-988-5423
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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 | 503-988-5423
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Fax | 503-988-4345
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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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 | RP-0002772-CS
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License Number State | OR
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