Provider Demographics
NPI:1235747775
Name:CORDANT PHARMACY OREGON, LLC
Entity Type:Organization
Organization Name:CORDANT PHARMACY OREGON, LLC
Other - Org Name:ST. MATTHEWS PHARMACY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-314-0146
Mailing Address - Street 1:9500 ORMSBY STATION RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4076
Mailing Address - Country:US
Mailing Address - Phone:502-205-1729
Mailing Address - Fax:
Practice Address - Street 1:6135 NE 80TH AVE STE A2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-4033
Practice Address - Country:US
Practice Address - Phone:817-572-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORDANT PHARMACY OREGON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-21
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy