1033178421 NPI number — HI SCHOOL PHARMACY OF OREGON INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033178421 NPI number — HI SCHOOL PHARMACY OF OREGON INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HI SCHOOL PHARMACY OF OREGON INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033178421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 W EVERGREEN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98660-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-213-2236
Provider Business Mailing Address Fax Number:
360-213-2238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5639 HOOD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LINN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97068-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-656-0306
Provider Business Practice Location Address Fax Number:
503-650-7855
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEIS
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARMACY
Authorized Official Telephone Number:
503-507-6073

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  RP0000589CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 070636 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3811975 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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