Provider Demographics
NPI:1154729119
Name:PROVIDENCE NEWBERG PHARMACY
Entity type:Organization
Organization Name:PROVIDENCE NEWBERG PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANZANTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-537-1798
Mailing Address - Street 1:1001 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7485
Mailing Address - Country:US
Mailing Address - Phone:503-537-1798
Mailing Address - Fax:503-537-1813
Practice Address - Street 1:1001 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7485
Practice Address - Country:US
Practice Address - Phone:503-537-1798
Practice Address - Fax:503-537-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural