MPKM, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP0000689-C Issued in OR

Legal business name

MPKM, LLC

Practice address

10000 SE Main St Ste 118
Portland, OR 97216-2462

Phone

(702) 203-4797

NPI assigned

Oct 17, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Hogan Peters

Title

Owner

Phone

(702) 203-4797

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1588917447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 SARI DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891104227",
            "telephone_number": "702-203-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 118",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162462",
            "telephone_number": "702-203-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MPKM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "HOGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-203-4797",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP0000689-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Portland, OR
• Providers in Portland, 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 Oct 17, 2012; 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.