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GRESHAM PROFESSIONAL PHARMACY NPI 1063401198


NPI Information

NPI: 1063401198
Provider Name: GRESHAM PROFESSIONAL PHARMACY
Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
24076 SE STARK ST
SUITE 100
GRESHAM, OR
ZIP 97030
Phone: (503) 491-0117
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GRESHAM PROFESSIONAL PHARMACY is a community/retail pharmacy pharmacy in Gresham, OR. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. GRESHAM PROFESSIONAL PHARMACY NPI is 1063401198. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

24076 SE STARK ST
SUITE 100
GRESHAM, OR
ZIP 97030-373
Phone: (503) 491-0117
Fax: (503) 489-2078

The provider's authorized official is David G Moll .
The authorized official title is Ceo and has the following contact phone number (503) 491-0117.

The enumeration date for this NPI number is 10/20/2005 and was last updated on 10/21/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1183500000XPharmacist8305OREGONNo
23336C0003XPharmacyCommunity/Retail Pharmacy002102OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1299911MEDICAIDOREGON
23815125OTHEROREGONNABP/NCPDP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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