Maple Street Clinic Pharmacy
LBN: Maple Street Clinic Pharmacy Llc
Maple Street Clinic Pharmacy is an health care organization with primary practice located at 1825 Maple St , Forest Grove OR 97116-1939. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Clinic Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Clinic Pharmacy is the primary health care specialty.
Maple Street Clinic Pharmacy Llc can be contacted via phone (503) 357-7552, or through Vorrath, Christopher via phone (503) 357-7552.
Contact Information
Primary practice address
1825 Maple St
Forest Grove OR 97116-1939
Phone: (503) 357-7552
Fax: (503) 359-5071
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Clinic Pharmacy | 3336C0002X | RP0000674CS | Oregon |
| Suppliers / Community/Retail Pharmacy | 3336C0003X |
Profile Details
| NPI number | 1912064478 |
|---|---|
| LBN Legal business name | Maple Street Clinic Pharmacy Llc |
| DBA Doing business as | Maple Street Clinic Pharmacy |
| Authorized official | Vorrath, Christopher PHRM |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 3rd, 2007 |
| Last updated | Jun 23rd, 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 | 1912064478 | NPPES |
| Oregon | MEDICAID | 0003280 | |
| Oregon | Other | 3810163 | |
| Oregon | Other | 3810163 |
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