Provider Demographics
NPI:1790878973
Name:OREGON HEALTH & SCIENCE UNIVERSITY
Entity Type:Organization
Organization Name:OREGON HEALTH & SCIENCE UNIVERSITY
Other - Org Name:OHSU CHH RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR, EVP & CEO, OHSU HLTH SYS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:503-494-8744
Mailing Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Mailing Address - Street 2:MAIL CODE: 9A13
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-8007
Mailing Address - Fax:503-494-5094
Practice Address - Street 1:3303 SW BOND AVE.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-418-9898
Practice Address - Fax:503-418-9897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON HEALTH AND SCIENCE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002347-CS333600000X, 3336C0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242107Medicaid
ID808229800Medicaid
AKPH026 ORMedicaid
WA1045684Medicaid
3842526OtherNCPDP
OR242107Medicaid