Provider Demographics
NPI:1689694150
Name:LEGACY MERIDIAN PARK HOSPITAL
Entity Type:Organization
Organization Name:LEGACY MERIDIAN PARK HOSPITAL
Other - Org Name:LEGACY MERIDIAN PARK HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-415-5730
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4037
Mailing Address - Country:US
Mailing Address - Phone:503-413-3958
Mailing Address - Fax:
Practice Address - Street 1:19300 SW 65TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7706
Practice Address - Country:US
Practice Address - Phone:503-692-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY MERIDIAN PARK HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0000864-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3810567OtherNCPDP