1245085174 NPI number — STRATEGIC PHARMACEUTICAL SOLUTIONS, INC. MINORITY SHAREHOLDERS

Table of content: (NPI 1245085174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245085174 NPI number — STRATEGIC PHARMACEUTICAL SOLUTIONS, INC. MINORITY SHAREHOLDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATEGIC PHARMACEUTICAL SOLUTIONS, INC. MINORITY SHAREHOLDERS
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:
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:
1245085174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17014 NE SANDY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97230-5074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4251 DALE EARNHARDT BLVD.
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
NORTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-738-4443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HYSEN
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
REGULATORY ASSOCIATE
Authorized Official Telephone Number:
503-802-7400

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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