Provider Demographics
NPI:1225073448
Name:CONSONUS PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:CONSONUS PHARMACY SERVICES LLC
Other - Org Name:CONSONUS PHARMACY SERVICES OREGON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-206-5172
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4628
Mailing Address - Country:US
Mailing Address - Phone:971-206-5205
Mailing Address - Fax:503-961-7781
Practice Address - Street 1:4560 SE INTERNATIONAL WAY
Practice Address - Street 2:STE 101
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:971-206-5205
Practice Address - Fax:503-961-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
ORIP0002138CS3336L0003X
OR5118040001332B00000X
ORIP-0002138-CS3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274985Medicaid
OR277852Medicaid
2079270OtherPK
ID806932500Medicaid
WA6027288Medicaid
ID806932500Medicaid