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General NPI Number Information
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NPI Number | 1780769398
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Entity Type | Organization
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Legal Business Name | ELLINGSON'S INC.
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6620 NE 79TH CT SUITE 1
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City | PORTLAND
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State | OR
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Zip | 97218-2862
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Country | US
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Telephone | 503-257-3373
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Fax | 503-408-9041
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Provider Business Mailing Address
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Address Line | 6620 NE 79TH CT SUITE 1
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City | PORTLAND
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State | OR
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Zip | 97218-2862
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Country | US
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Telephone | 503-257-3373
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Fax | 503-408-9041
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK VICTOR ELLINGSON
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Credential |
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Telephone | 503-257-3373
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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 | RP-0000952-CS
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License Number State | OR
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