Provider Demographics
NPI:1164780532
Name:UNIVERSITY COMPOUNDERS LLC
Entity Type:Organization
Organization Name:UNIVERSITY COMPOUNDERS LLC
Other - Org Name:PROGRESS HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-427-0361
Mailing Address - Street 1:9150 SW PIONEER CT
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9623
Mailing Address - Country:US
Mailing Address - Phone:503-427-0361
Mailing Address - Fax:971-224-4385
Practice Address - Street 1:9150 SW PIONEER CT
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9623
Practice Address - Country:US
Practice Address - Phone:503-427-0361
Practice Address - Fax:971-224-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336I0012X
ORRP-0002240-CS3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134542OtherPK
6716220001Medicare NSC
6716220001Medicare NSC
2134542OtherPK