MEDICARE: CONSONUS PHARMACY SERVICES LLC

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	3336I0012X	Institutional Pharmacy
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy	IP0002138CS	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2079270	OTHER	PK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225073448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSONUS PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	4560 SE INTERNATIONAL WAY
Second Line	:	STE 101
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	971-206-5205
Fax Number	:	503-961-7781

Provider Business Practice Location Address
First Line	:	4560 SE INTERNATIONAL WAY
Second Line	:	STE 101
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	971-206-5205
Fax Number	:	503-961-7781

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	TAMI LAFLEN
Credential	:
Telephone Number	:	971-206-5172

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/14/2016

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Directions to “CONSONUS PHARMACY SERVICES LLC ” Practice Location

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