Provider Demographics
NPI:1134164353
Name:ASSURED PHARMACY
Entity type:Organization
Organization Name:ASSURED PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPS OFC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-222-9971
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-0023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10196 SW PARK WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5008
Practice Address - Country:US
Practice Address - Phone:503-292-0045
Practice Address - Fax:503-292-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0002215CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3841889OtherOTHER ID NUMBER-COMMERCIAL NUMBER