| |
11516 Se Mill Plain Blvd Ste 2e Suite 2e Vancouver WA 98684-5082 | |
(503) 775-4931 | |
(503) 788-7285 |
Full Name | |
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Speciality | Non-pharmacy Dispensing Site |
Location | 11516 Se Mill Plain Blvd Ste 2e, Vancouver, Washington |
Authorized Official Name and Position | Stacy Cross (PRESIDENT & CEO) |
Authorized Official Contact | 5037754931 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3727 Ne Martin Luther King Jr Blvd Portland OR 97212-1112 Ph: (503) 775-4931 | 11516 Se Mill Plain Blvd Ste 2e Suite 2e Vancouver WA 98684-5082 Ph: (503) 775-4931 |
NPI Number | 1699144865 |
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Provider Enumeration Date | 09/17/2015 |
Last Update Date | 09/17/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699144865 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
332900000X | Non-pharmacy Dispensing Site | (* (Not Available)) | Primary |
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