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NPI Code Detail

MEDICARE: D & S HOMETOWN PHARMACIES INC

MEDICARE: D & S HOMETOWN PHARMACIES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23806087OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1043324023
Entity Type Code : Organization
Provider Name (Legal Business Name) : D & S HOMETOWN PHARMACIES INC
Provider Business Mailing Address
First Line : 7410 SW OLESON RD
Second Line : #420
City : PORTLAND
State : OR
Zip : 97223-7475
Country : US
Telephone Number : 503-244-4508
Fax Number : 503-246-0654
Provider Business Practice Location Address
First Line : 7410 SW OLESON RD
Second Line :
City : PORTLAND
State : OR
Zip : 97223-7475
Country : US
Telephone Number : 503-244-4508
Fax Number : 503-246-0654
Authorized Official
Title or Position : OWNER
Name : MR. MARK EDWIN SARGEANT
Credential : RPH
Telephone Number : 503-244-4508
Provider Enumeration Date : 08/18/2006
Last Update Date : 08/17/2007

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Directions to “D & S HOMETOWN PHARMACIES INC ” Practice Location

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