MEDICARE: ASSURED PHARMACY

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	RP0002215CS	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3841889	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1134164353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURED PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	FRANKLIN PARK
State	:	NJ
Zip	:	08823-0023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10196 SW PARK WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5008
Country	:	US
Telephone Number	:	503-292-0045
Fax Number	:	503-292-0059

Authorized Official
Title or Position	:	CHIEF OPS OFC
Name	:	JOHN MUTTER
Credential	:
Telephone Number	:	949-222-9971

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	08/22/2020

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Directions to “ASSURED PHARMACY ” Practice Location

Language	Start Address	Practice Location

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