| NPI | 1346507613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL BEBEL STARGROVE President 503-520-1741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: OR 696) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2012-04-11 |