National Provider Identifier Database

MEDICATION MANAGEMENT PROGRAM
Clinic Pharmacy

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.


Contact Information

MEDICATION MANAGEMENT PROGRAM
5717 NE 138TH AVE
PORTLAND, OR97230-3409
Phone: 503-261-7541
Fax: 503-261-2048
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X

* Indicates primary specialty

NPI Profile & details for MEDICATION MANAGEMENT PROGRAM

NPI Number 1720493968
Legal business name
LBN
MEDICATION MANAGEMENT PROGRAM
Authorized official STEVE LOGAN - (DIRECTOR, PHARMACY)
Entity Organization
Organization subpart No
Enumeration date 06/26/2014
Last updated 06/01/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • OR License #: 2131
  • WA License #: 00058657
  • OR Medicaid: 136668
  • WA Medicaid: 6019392
  • Other: 2146486 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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