MEDICARE: PORTLAND PRESCRIPTION SHOP PLLC

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
1	3336C0003X	Community/Retail Pharmacy	5451	TN
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043612880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTLAND PRESCRIPTION SHOP PLLC

Provider Business Mailing Address
First Line	:	705 S BROADWAY ST
Second Line	:	P.O. BOX 910
City	:	PORTLAND
State	:	TN
Zip	:	37148-1628
Country	:	US
Telephone Number	:	615-323-5050
Fax Number	:	615-323-5052

Provider Business Practice Location Address
First Line	:	705 S BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1628
Country	:	US
Telephone Number	:	615-323-5050
Fax Number	:	615-323-5052

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL E STINNETT
Credential	:	RPH
Telephone Number	:	270-392-4248

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	08/24/2023

Similar Medicare Providers

1376752220 — MR. MICHAEL E STINNETT RPH
Practice Location Address:

705 S BROADWAY ST
PORTLAND, TN
37148-1628

Practice Phone: 270-842-4515
Practice Fax: 270-901-0187

1922245661 — MARCOS FRANCO PT
Practice Location Address:

705 S BROADWAY ST , STE B
PORTLAND, TN
37148-1628

Practice Phone: 615-325-9007
Practice Fax: 615-325-5794

1881076321 — DR. SHANE MOUSER PHARM.D.
Practice Location Address:

705 S BROADWAY ST
PORTLAND, TN
37148-1628

Practice Phone: 615-323-5050
Practice Fax: 615-323-5052

1669294195 — AFFINITY THERAPY LLC
Practice Location Address:

705 S BROADWAY ST # 1011
PORTLAND, TN
37148-1628

Practice Phone: 615-953-0390
Practice Fax:

1629123989 — MS. AMY ELIZABETH YEE QMHP
Practice Location Address:

4212 SE DIVISION ST
PORTLAND, OR
97206-1628

Practice Phone: 503-963-2569
Practice Fax: 503-963-2572

1396891289 — JENNIFER WILCOX
Practice Location Address:

4212 SE DIVISION ST , SUITE 100
PORTLAND, OR
97206-1628

Practice Phone: 503-238-0705
Practice Fax:

Directions to “PORTLAND PRESCRIPTION SHOP PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.