Legacy Meridan Park Hospital

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP-0000864 Issued in OR

Legal business name

LEGACY MERIDAN PARK HOSPITAL

Doing business as

Meridian Park Medical Center Community Pharmacy

Practice address

19300 SW 65TH Ave
Tualatin, OR 97062-7706

Phone

(503) 692-7470

Fax

(503) 692-7437

NPI assigned

Feb 21, 2014

Organization subpart

No

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

Authorized official

Name

Michael Sieg, RPH

Title

Phcy Srvcs MGR

Phone

(503) 692-2665

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Meridian Park Medical Center Community Pharmacy Doing business as

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

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1497170849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19300 SW 65TH AVE",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627706",
            "telephone_number": "503-692-2454",
            "fax_number": "503-692-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19300 SW 65TH AVE",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627706",
            "telephone_number": "503-692-7470",
            "fax_number": "503-692-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MERIDAN PARK HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-21",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "SIEG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHCY SRVCS MGR",
        "authorized_official_telephone_number": "503-692-2665",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0000864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144384",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian Park Medical Center Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Corinne Cristina Lazo
• Peter Rylan Lebray, PH.D.
• Kenneth M Leclerc, M.D.
• Christina Lee, M.D.
• Sarah Chungmi Lee
• Legacy Meridian Park Hospital
• Legacy Meridian Park Hospital
• Legacy Meridian Park Hospital (Legacy Meridian Park Hospital Pharmacy)
• Legacy Meridian Park Pediatric Rehab
• Legacy Visiting Nurse Association (Legacy Hospice Services)

• Community/Retail Pharmacy in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Community/Retail Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.