Provider Demographics
NPI:1194313619
Name:PRESCRYPTIVE PHARMACY & PATIENT SERVICES INC
Entity type:Organization
Organization Name:PRESCRYPTIVE PHARMACY & PATIENT SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:541-526-3565
Mailing Address - Street 1:2127 S HIGHWAY 97 STE 150
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0320
Mailing Address - Country:US
Mailing Address - Phone:541-526-3565
Mailing Address - Fax:866-922-4730
Practice Address - Street 1:2127 S HIGHWAY 97 STE 150
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-0320
Practice Address - Country:US
Practice Address - Phone:206-413-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy