Gresham Professional Pharmacy
LBN: Gresham Professional Pharmacy
Gresham Professional Pharmacy is an health care organization with primary practice located at 24076 Se Stark St Suite 100, Gresham OR 97030-3373. The organization recently has 2 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacist, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Gresham Professional Pharmacy can be contacted via phone (503) 491-0117, or through Moll, David G via phone (503) 491-0117.
Contact Information
Primary practice address
24076 Se Stark St Suite 100
Gresham OR 97030-3373
Phone: (503) 491-0117
Fax: (503) 489-2078
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Pharmacy Service Providers / Pharmacist | 183500000X | 8305 | Oregon |
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 002102 | Oregon |
Profile Details
| NPI number | 1063401198 |
|---|---|
| LBN Legal business name | Gresham Professional Pharmacy |
| DBA Doing business as | |
| Authorized official | Moll, David G PHARMD |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 20th, 2005 |
| Last updated | Oct 21st, 2008 - about 16 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063401198 | NPPES |
| Oregon | MEDICAID | 299911 | |
| Oregon | Other | 3815125 |
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