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General NPI Number Information
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NPI Number | 1598831133
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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 | 11/27/2006
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 10150 SE 32ND AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-6516
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Country | US
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Telephone | 503-513-8331
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Fax | 503-513-8324
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Provider Business Mailing Address
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Address Line | 10150 SE 32ND AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-6516
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Country | US
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Telephone | 503-513-8331
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Fax | 503-513-8324
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | SUZANNE ANTHONY
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Credential | RPH
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Telephone | 503-513-8381
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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 | RP0000827CS
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License Number State | OR
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