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Active NPI 1063401198 Organization (Entity Type 2)

Gresham Professional Pharmacy

Pharmacy - Community/Retail Pharmacy • Gresham, OR

About Gresham Professional Pharmacy NPI 1063401198 Summary

Gresham Professional Pharmacy is a verified healthcare organization specializing in Pharmacy - Community/Retail Pharmacy operating in Gresham, OR. Located at 24076 SE STARK ST, SUITE 100, this facility provides patient care and medical services under National Provider Identifier (NPI) 1063401198.

Administrative operations and authorized compliance are overseen by David Moll (Ceo).

The facility is associated with 20 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

24076 Se Stark St
Suite 100

Gresham, OR 970303373

Telephone 5034910117
Fax 5034892078

Authorized Official Information

Authorized Contact Name

DR. David Moll , PHARMD

Title / Role

Ceo

Official Telephone

5034910117

Facility Classifications & Specialties

Pharmacy - Community/Retail Pharmacy Primary Taxonomy

NUCC Taxonomy Code: 3336C0003X

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Pharmacist

NUCC Taxonomy Code: 183500000X

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

20 Linked
Clem Eischen , PT NPI 1043292311

Physical Therapist

Gresham, OR

View Practitioner Profile →

Otolaryngology

Gresham, OR

View Practitioner Profile →

Specialist

Gresham, OR

View Practitioner Profile →
Jess Meyer , PA-C NPI 1245256981

Physician Assistant - Surgical

Gresham, OR

View Practitioner Profile →

Otolaryngology

Gresham, OR

View Practitioner Profile →

Podiatrist - Foot & Ankle Surgery

Gresham, OR

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active October 21, 2008

NPI status registered as active in NPPES database

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Updated Practice Location October 21, 2008

Registered at 24076 SE STARK ST, SUITE 100, GRESHAM, OR 970303373 (Tel: 5034910117)

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Updated Business Mailing Address October 21, 2008

Registered at 24076 SE STARK ST, SUITE 100, GRESHAM, OR 970303373 (Tel: 5034910117)

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Organization / Clinic Name Updated October 21, 2008

Operating as GRESHAM PROFESSIONAL PHARMACY

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 21, 2008

Pharmacist (License #8305 in OR)

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Initial NPI Registration & Enumeration October 20, 2005

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1063401198
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: October 20, 2005
Last Update: October 21, 2008

Mailing Address

24076 Se Stark St, Suite 100

Gresham, OR 970303373

Phone: 5034910117

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.