MEDICATION MANAGEMENT PROGRAM; NPI #1720493968

Contact Information

MEDICATION MANAGEMENT PROGRAM

5717 NE 138TH AVE
PORTLAND, OR 97230-3409

Phone: 503-261-7541
Fax: 503-261-2048
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Clinic Pharmacy	3336C0002X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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NPI Profile & details for MEDICATION MANAGEMENT PROGRAM

NPI Number 1720493968

LBN Legal business name MEDICATION MANAGEMENT PROGRAM

Authorized official STEVE LOGAN - (DIRECTOR, PHARMACY)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/26/2014

Last updated 06/01/2021 - About 5 years ago

Identifiers

OR	License #	2131
WA	License #	00058657
OR	Medicaid	136668
WA	Medicaid	6019392
	Other	2146486	PK

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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