Provider Demographics
NPI:1669496204
Name:MULTNOMAH COUNTY INVERNESS JAIL PHARMACY
Entity Type:Organization
Organization Name:MULTNOMAH COUNTY INVERNESS JAIL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHARMACIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-988-3674
Mailing Address - Street 1:619 NW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3964
Mailing Address - Country:US
Mailing Address - Phone:503-988-3674
Mailing Address - Fax:503-988-4345
Practice Address - Street 1:11540 NE INVERNESS DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9002
Practice Address - Country:US
Practice Address - Phone:503-988-4134
Practice Address - Fax:503-988-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR100476261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR100476OtherOREGON PHARMACY LICENSE #
OR100476OtherOREGON PHARMACY LICENSE #