Professional 205 Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP,0000689 Issued in OR

Legal business name

PROFESSIONAL 205 PHARMACY

Doing business as

Professional Center 205 Pharmacy

Practice address

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

Phone

(503) 255-2546

Fax

(503) 255-3893

NPI assigned

Jul 8, 2016

Organization subpart

No

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

Authorized official

Name

Susan Hodge

Title

Owner

Phone

(503) 255-2546

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Professional Center 205 Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1639521149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 SE MAIN ST STE 118",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162462",
            "telephone_number": "503-255-2546",
            "fax_number": "503-255-3893"
        },
        {
            "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": "503-255-2546",
            "fax_number": "503-255-3893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL 205 PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-08",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "HODGE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-255-2546"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP,0000689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160623",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Center 205 Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aaron R. Proctor, OTD
• Cheryl Leslie Proctor, MSW, CADC II
• Shirley Ann Proctor, MSW
• Gabrielle Prodigue, MA
• Becky Lynn Prodoehl, BS
• Professional Health Care LLC
• Professional Health Care LLC
• Professional Home Care Services
• Professional Medical Services LLC
• Professional Medical Services LLC

• 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 Aug 17, 2016; 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.