Maple Street Clinic Pharmacy LLC

Primary specialty

Clinic PharmacyTaxonomy code 3336C0002X

License

RP0000674CS Issued in OR

Legal business name

MAPLE STREET CLINIC PHARMACY LLC

Doing business as

Maple Street Clinic Pharmacy

Practice address

1825 Maple St
Forest Grove, OR 97116-1939

Phone

(503) 357-7552

Fax

(503) 359-5071

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Christopher Vorrath, PHRM

Title

Pres

Phone

(503) 357-7552

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• MAPLE STREET CLINIC PHARMACY Doing business as

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1912064478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 MAPLE ST",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 MAPLE ST",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971161939",
            "telephone_number": "503-357-7552",
            "fax_number": "503-359-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE STREET CLINIC PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "VORRATH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "503-357-7552",
        "authorized_official_credential": "PHRM"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "OR",
            "license": "RP0000674CS",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003280",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3810163",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3810163",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAPLE STREET CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aidan J Lynch
• Christine June Ma
• Mandy Mie Yu Mah
• Managed Health Care of Oregon I LLC (Managed Healthcare of Or LLC)
• Cristina Leigh Mandera, LMT
• Maple Street Clinic, PC
• Noah Marek, PT
• Marilyn J Booth MD
• Marquis Companies II, Inc (Marquis Forest Grove Assisted Living)
• Marquis Companies II, Inc. (Marquis Forest Grove Post Acute Rehab)

• Clinic Pharmacy in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Clinic Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.