NPIMap

Organization Active NPI

Columbia Pharmacy LLC

  • Community/Retail Pharmacy
  • Portland, OR
National Provider Identifier
1104121938
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COLUMBIA PHARMACY LLC
Practice address
8122 SE Tibbetts St.
Portland, OR 97206
Phone
(503) 777-7055
Fax
(503) 384-2417
NPI assigned
Jan 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hanh H Nguyen
Title
Manager
Phone
(206) 245-5010

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Mail Order Pharmacy 3336M0002X

Addresses

Primary practice location

8122 SE Tibbetts St.
Portland, OR 97206

Mailing address

8122 SE Tibbetts St.
Portland, OR 97206
Phone (503) 777-7055

Other identifiers 1

IdentifierTypeStateIssuer
500634523MedicaidOR

National Provider Directory

National Provider Directory

Locations

8122 SE Tibbetts St
Portland, OR 97206
Phone (503) 255-1111

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1104121938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8122 SE TIBBETTS ST.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97206",
            "telephone_number": "503-777-7055",
            "fax_number": "503-384-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8122 SE TIBBETTS ST.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97206",
            "telephone_number": "503-777-7055",
            "fax_number": "503-384-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-26",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "HANH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "206-245-5010"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500634523",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.