| Vaccine Depot | |
|
619 Nw 6th Ave Portland OR 97209-3964 | |
| (503) 988-7468 | |
| (503) 988-3015 |
| Full Name | Vaccine Depot |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 619 Nw 6th Ave, Portland, Oregon |
| Authorized Official Name and Position | Derrick Moten (INTERIM BUSINESS SERVICES DIRECTOR) |
| Authorized Official Contact | 5039882966 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vaccine Depot 619 Nw 6th Ave Portland OR 97209-3964 Ph: (503) 988-7468 | Vaccine Depot 619 Nw 6th Ave Portland OR 97209-3964 Ph: (503) 988-7468 |
| NPI Number | 1023451044 |
|---|---|
| Provider Enumeration Date | 04/09/2013 |
| Last Update Date | 05/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023451044 | NPI | - | NPPES |
| 022959 | Medicaid | OR | |
| 096511 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |
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