Provider Demographics
NPI:1891853552
Name:NEW SEASON MARKET PHARMACY
Entity Type:Organization
Organization Name:NEW SEASON MARKET PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHAMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-445-3100
Mailing Address - Street 1:1954 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:503-445-3100
Mailing Address - Fax:503-546-3910
Practice Address - Street 1:1954 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-445-3100
Practice Address - Fax:503-546-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
ORRP0002196CS3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233492Medicaid
OR5272700001Medicare ID - Type Unspecified