Provider Demographics
NPI:1720178783
Name:VIRGINIA GARCIA MEMORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:VIRGINIA GARCIA MEMORIAL HEALTH CENTER
Other - Org Name:VG HILLSBORO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ETHERIDGE
Authorized Official - Last Name:HIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-352-8553
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-0568
Mailing Address - Country:US
Mailing Address - Phone:503-352-8610
Mailing Address - Fax:503-359-8532
Practice Address - Street 1:226 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-601-7410
Practice Address - Fax:503-601-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ORRP00023493336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241292Medicaid
2079480OtherPK