Provider Demographics
NPI:1699197459
Name:SPECIALTY PHARMCY, INC
Entity type:Organization
Organization Name:SPECIALTY PHARMCY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:503-303-7111
Mailing Address - Street 1:9150 SW PIONEER CT STE E
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9623
Mailing Address - Country:US
Mailing Address - Phone:503-303-7111
Mailing Address - Fax:503-210-0388
Practice Address - Street 1:9150 SW PIONEER CT STE E
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9623
Practice Address - Country:US
Practice Address - Phone:503-303-7111
Practice Address - Fax:203-210-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy