Provider Demographics
NPI:1053454645
Name:OREGON HEALTH AND SCIENCE UNIVERSITY
Entity Type:Organization
Organization Name:OREGON HEALTH AND SCIENCE UNIVERSITY
Other - Org Name:OHSU DOERNBECHER CHILDRENS HOSP. PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR, EVP & CEO OHSU HLTH SYS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:503-494-8744
Mailing Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Mailing Address - Street 2:MAIL CODE: 9A13
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-8007
Mailing Address - Fax:503-494-5094
Practice Address - Street 1:700 SW CAMPUS DR STE 7480
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3107
Practice Address - Country:US
Practice Address - Phone:503-418-5244
Practice Address - Fax:503-494-3506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON HEALTH AND SCIENCE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0001639-CS3336C0002X, 3336C0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPH004 ORMedicaid
IDM8082300Medicaid
3842704OtherNCPDP
OR242111Medicaid
WA2010102Medicaid
OR242111Medicaid