1235380783 NPI number — MATTHEW SCOTT BORISCH PHARM. D.

Table of content: MATTHEW SCOTT BORISCH PHARM. D. (NPI 1235380783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235380783 NPI number — MATTHEW SCOTT BORISCH PHARM. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORISCH
Provider First Name:
MATTHEW
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1235380783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14001
Provider Second Line Business Mailing Address:
RETAIL PHARMACY, BUILDING C
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97309-5014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-814-9988
Provider Business Mailing Address Fax Number:
503-814-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 OAK ST SE
Provider Second Line Business Practice Location Address:
RETAIL PHARMACY
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-814-0412
Provider Business Practice Location Address Fax Number:
503-814-0407
Provider Enumeration Date:
10/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH-0010617 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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