Provider Demographics
NPI:1164647897
Name:HUBBELL, PATRICK SCOTT (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:SCOTT
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2427
Mailing Address - Country:US
Mailing Address - Phone:503-234-8348
Mailing Address - Fax:503-235-0373
Practice Address - Street 1:3131 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2427
Practice Address - Country:US
Practice Address - Phone:503-234-8348
Practice Address - Fax:503-235-0373
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14036183500000X, 1835P0018X
KS11960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500724546Medicaid