Provider Demographics
NPI:1033178421
Name:HI SCHOOL PHARMACY OF OREGON INC
Entity Type:Organization
Organization Name:HI SCHOOL PHARMACY OF OREGON INC
Other - Org Name:HI-SCHOOL PHARMACY #4900
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKESLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-213-2236
Mailing Address - Street 1:916 W EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3035
Mailing Address - Country:US
Mailing Address - Phone:360-213-2236
Mailing Address - Fax:360-213-2238
Practice Address - Street 1:5639 HOOD STREET
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3241
Practice Address - Country:US
Practice Address - Phone:503-656-0306
Practice Address - Fax:503-650-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0000589CS333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3811975OtherNCPDP
OR070636Medicaid
3811975OtherNCPDP