Provider Demographics
NPI:1457396731
Name:KASPRZYK ENTERPRISES, INC.
Entity Type:Organization
Organization Name:KASPRZYK ENTERPRISES, INC.
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPRZYK
Authorized Official - Suffix:
Authorized Official - Credentials:RHH
Authorized Official - Phone:503-623-5998
Mailing Address - Street 1:289 E ELLENDALE AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1580
Mailing Address - Country:US
Mailing Address - Phone:503-623-5998
Mailing Address - Fax:503-623-1173
Practice Address - Street 1:289 E ELLENDALE AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1580
Practice Address - Country:US
Practice Address - Phone:503-623-5998
Practice Address - Fax:503-623-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ORRP-0001132-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR020565Medicaid
OR3810416OtherNCPDP
ORBK3940029OtherDEA #
OR121297Medicare PIN
ORBK3940029OtherDEA #