NPIMap

Organization Active NPI

Providence Health & Services Oregon

Doing business as Providence Bridgeport Pharmacy

  • Community/Retail Pharmacy
  • Tigard, OR
National Provider Identifier
1922330828
Registry record updated Jul 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RP-0002571-CS Issued in OR
Legal business name
PROVIDENCE HEALTH & SERVICES OREGON
Doing business as
Providence Bridgeport Pharmacy
Practice address
18040 SW Lower Boones Ferry Rd Ste 104
Tigard, OR 97224-7259
Phone
(503) 216-0625
Fax
(503) 216-0630
NPI assigned
Feb 3, 2010
Last updated
Jul 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2025

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secreatry for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X RP-0002571-CS OR Primary

Addresses

Primary practice location

18040 SW Lower Boones Ferry Rd Ste 104
Tigard, OR 97224-7259

Mailing address

18040 SW Lower Boones Ferry Rd
Suite 104
Tigard, OR 97224-7258
Phone (503) 216-0625

Other identifiers 1

IdentifierTypeStateIssuer
3843768OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Providence Bridgeport Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prov Family Med-North P18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751932800000",
    "number": "1922330828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18040 SW LOWER BOONES FERRY RD",
            "address_2": "SUITE 104",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247258",
            "telephone_number": "503-216-0625",
            "fax_number": "503-216-0630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18040 SW LOWER BOONES FERRY RD STE 104",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247259",
            "telephone_number": "503-216-0625",
            "fax_number": "503-216-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-03",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECREATRY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0002571-CS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3843768",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Bridgeport Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; 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.