MEDICARE: NORTH COAST PHARMACY 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
1	183500000X	Pharmacist	AN8475344	OR
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881626901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COAST PHARMACY INC

Provider Business Mailing Address
First Line	:	1319 COMMERCIAL ST
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-3915
Country	:	US
Telephone Number	:	503-325-4541
Fax Number	:	503-325-6827

Provider Business Practice Location Address
First Line	:	1319 COMMERCIAL ST
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-3915
Country	:	US
Telephone Number	:	503-325-4541
Fax Number	:	503-325-6827

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. EDWIN E TREHARNE JR.
Credential	:
Telephone Number	:	503-325-4541

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/22/2023

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Directions to “NORTH COAST PHARMACY INC ” Practice Location

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