NPI 1255102794 · live from the CMS NPI Registry
1918 Winter Street Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Portland, OR. National Provider Identifier 1255102794, active.
NPI record
| NPI | 1255102794 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 5920 Ne Martin Luther King Blvd, Portland, OR 97211 |
| Practice phone | 503-288-3272 |
| Mailing address | 7 Corporate Dr, Keene, NH 03431 |
| Enumerated | January 12, 2024 |
| Last updated | July 24, 2024 |
| Authorized official | Kevin Mcnamara, Authorized Person |
| Other names | Safeway Pharmacy #0509 |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | — |
| Pharmacy, Community/Retail Pharmacy primary | 3336C0003X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.