1225073448 NPI number — CONSONUS PHARMACY SERVICES LLC

Table of content: (NPI 1225073448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225073448 NPI number — CONSONUS PHARMACY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSONUS PHARMACY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225073448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4560 SE INTERNATIONAL WAY
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
MILWAUKIE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97222-4628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-206-5205
Provider Business Mailing Address Fax Number:
503-961-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4560 SE INTERNATIONAL WAY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-4628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-206-5205
Provider Business Practice Location Address Fax Number:
503-961-7781
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAFLEN
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
971-206-5172

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: IP0002138CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 274985 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 277852 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2079270 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806932500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6027288 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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