| NPI | 1619721784 |
|---|---|
| Doing Business As | INTEGRIS HEALTH PORTLAND AVE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DONNA M WALLACE Assistant Treasurer 636-359-4890 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336I0012X Pharmacy, Institutional Pharmacy |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |