=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982797155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OREGON HEALTH & SCIENCE UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4411 SW VERMONT ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97219-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-494-2098
-----------------------------------------------------
Fax | 503-494-2255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3181 SW SAM JACKSON PARK RD MAIL CODE: CR9-4 PHARMACY COMPLIANCE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97239-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-494-8007
-----------------------------------------------------
Fax | 503-494-5094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, ERC
-----------------------------------------------------
Name | KELLY ANNE SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-494-4817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | RP0002250CS
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------