Provider Demographics
NPI: | 1992830723 |
---|---|
Name: | WELLPARTNER, INC |
Entity type: | Organization |
Organization Name: | WELLPARTNER, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PIC |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KENT |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | BLAIR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 503-718-5700 |
Mailing Address - Street 1: | 7216 SW DURHAM RD |
Mailing Address - Street 2: | SUITE P-200 |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97224-7594 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-718-5700 |
Mailing Address - Fax: | 503-718-5701 |
Practice Address - Street 1: | 7216 SW DURHAM RD |
Practice Address - Street 2: | SUITE P-200 |
Practice Address - City: | PORTLAND |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97224-7594 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-718-5700 |
Practice Address - Fax: | 503-718-5701 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-22 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | RPH - 0007146 | 183500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Single Specialty |