NPIMap

Organization Active NPI

Multnomah County Oregon

Doing business as Southeast Health Clinic Pharmacy

  • Clinic Pharmacy
  • Portland, OR
National Provider Identifier
1396087631
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
RP-0002772-CS Issued in OR
Legal business name
MULTNOMAH COUNTY OREGON
Doing business as
Southeast Health Clinic Pharmacy
Practice address
3653 SE 34TH Ave
Portland, OR 97202-3034
Phone
(503) 988-5423
Fax
(503) 988-4345
NPI assigned
Mar 25, 2013
Last updated
Nov 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Authorized official

Name
Michele Koder
Title
Pharmacy Director
Phone
(503) 988-7278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X RP-0002772-CS OR Primary

Addresses

Primary practice location

3653 SE 34TH Ave
Portland, OR 97202-3034

Mailing address

619 NW 6TH Ave FL 7
Portland, OR 97209-3964
Phone (503) 988-5423

Other identifiers 2

IdentifierTypeStateIssuer
3844621OtherNCPDP PROVIDER IDENTIFICATION NUMBER
123620MedicaidOR

Other names 1

  • Southeast Health Clinic Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Multnomah County Oregon89 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1364169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1396087631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 NW 6TH AVE FL 7",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093964",
            "telephone_number": "503-988-5423",
            "fax_number": "503-988-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3653 SE 34TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023034",
            "telephone_number": "503-988-5423",
            "fax_number": "503-988-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTNOMAH COUNTY OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-25",
        "last_updated": "2019-11-08",
        "status": "A",
        "authorized_official_last_name": "KODER",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "503-988-7278"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "OR",
            "license": "RP-0002772-CS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3844621",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123620",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Health Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeast Health Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 8, 2019; 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.