Portland Professional Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP-0003101-CS Issued in OR

Legal business name

PORTLAND PROFESSIONAL PHARMACY, LLC

Doing business as

Portland Professional Pharmacy

Practice address

11717 NE Glisan St
Portland, OR 97220-2141

Phone

(971) 200-8324

NPI assigned

Jul 9, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Susan Hodge

Title

Manager

Phone

(702) 203-4797

Specialties & licenses 1

Addresses

Other names 1

• Portland Professional Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1659755593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11717 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972202141",
            "telephone_number": "702-203-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11717 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972202141",
            "telephone_number": "971-200-8324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND PROFESSIONAL PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-09",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "HODGE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-203-4797",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0003101-CS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland Professional Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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 Aug 4, 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.