Provider Demographics
NPI:1982797155
Name:OREGON HEALTH & SCIENCE UNIVERSITY
Entity Type:Organization
Organization Name:OREGON HEALTH & SCIENCE UNIVERSITY
Other - Org Name:OHSU GABRIEL PARK 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 RD
Mailing Address - Street 2:MAIL CODE: 9A13
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8007
Mailing Address - Fax:503-494-5094
Practice Address - Street 1:4411 SW VERMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1020
Practice Address - Country:US
Practice Address - Phone:503-494-2098
Practice Address - Fax:503-494-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336C0003X
ORRP0002250CS3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1982797155Medicaid
WA1046485Medicaid
OR242116Medicaid
3842083OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AKPH027ORMedicaid
ID1982797155Medicaid