Provider Demographics
NPI:1730649757
Name:PEACEHEALTH NETWORKS ON DEMAND, LLC
Entity Type:Organization
Organization Name:PEACEHEALTH NETWORKS ON DEMAND, LLC
Other - Org Name:ZOOMCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:ALYSE
Authorized Official - Last Name:KEMPTON-HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:503-941-3807
Mailing Address - Street 1:11956 SW GARDEN PLACE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-941-3807
Mailing Address - Fax:503-941-3809
Practice Address - Street 1:11956 SOUTHWEST GARDEN PLACE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-941-3807
Practice Address - Fax:503-941-3809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEACE HEALTH NETWORKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy