Provider Demographics
NPI:1790878973
Name:OREGON HEALTH & SCIENCE UNIVERSITY
Entity type:Organization
Organization Name:OREGON HEALTH & SCIENCE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, ERC
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-494-8417
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:MAIL CODE: CR9-4 PHARMACY COMPLIANCE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-8007
Mailing Address - Fax:503-494-5094
Practice Address - Street 1:3303 SW BOND AVE.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-418-9898
Practice Address - Fax:503-418-9897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON HEALTH AND SCIENCE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002347-CS3336I0012X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242107Medicaid
ID808229800Medicaid
AKPH026 ORMedicaid
WA1045684Medicaid
3842526OtherNCPDP
OR242107Medicaid