| NPI | 1043260920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAYLEY FLORES Administrator 503-206-3059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2025-05-22 |