Provider Demographics
NPI:1245393016
Name:ASSURED PHARMACY NORTHWEST INC.
Entity Type:Organization
Organization Name:ASSURED PHARMACY NORTHWEST INC.
Other - Org Name:ASSURED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-222-9971
Mailing Address - Street 1:17935 SKY PARK CIR STE F
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4336
Mailing Address - Country:US
Mailing Address - Phone:949-222-9971
Mailing Address - Fax:949-271-5580
Practice Address - Street 1:3822 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1720
Practice Address - Country:US
Practice Address - Phone:503-238-4540
Practice Address - Fax:503-238-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002791 CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3815365OtherNCPDP