PORTLAND DRUG LLC (NPI# 1942611504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942611504 |
| Entity Type | Organization |
| Organization Name | PORTLAND DRUG LLC |
| Other Organization Name | PORTLAND DRUG STORE |
| Practice Address |
105 Hwy 65 South Portland AR 71663-0000 |
| Mailing Address |
Po Box 552 Lake Village AR 71653-0552 |
| Practice Telephone | 8707372813 |
| Practice Fax Number | 8707372781 |
| Mailing Telephone | 8702652220 |
| Mailing Fax Number | 8702653538 |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2014-05-16 |
| Authorized Official Name | DR. KHALIL LYNN CROUSE (OWNER/PHARMACIST) |
| Authorized Official Telephone | 8702652220 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
AR11429 | AR | Suppliers |
| Other Name | Type Code |
|---|---|
| Portland Drug Store | Doing Business As Name - Organization |
| Street Address |
105 HWY 65 SOUTH |
| City | PORTLAND |
| State | AR |
| Zip Code | 71663-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396074886 | Amy Floyd | Social Worker | 233 North Main, Portland, AR 71663 | 2009-12-14 |
| 1891942975 | Jeannie Rebecca Tucker | Counselor | 233 N Main, Portland, AR 71663 | 2008-08-20 |
| 1578770582 | Portland Drug Inc. | Pharmacy | 105 Hwy 165 South, Portland, AR 71663 | 2007-05-17 |
| 1316106388 | Mainline Health Systems Inc | Clinic/Center | 233 N Main St, Portland, AR 71663 | 2008-06-05 |
| 1982128096 | Myra Brooke Flemister | Nurse Practitioner | 233 N Main St, Portland, AR 71663-9230 | 2017-07-31 |
| 1376841247 | Byron K Montgomery | Nurse Practitioner | 233 N Main St, Portland, AR 71663-9230 | 2011-03-02 |
| 1649636986 | Mainline Health Systems, Inc | Clinic/Center | 314 Highway 160 E, Portland, AR 71663-9262 | 2015-12-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013712 | Gabriel Henriques | Massage Therapist | 805 Se Peacock Ln, Portland, OR 97214-3278 | 2020-11-07 |
| 1669073490 | Krista Marie Obenlock | Acupuncturist | 2408 N Baldwin St, Portland, OR 97217-6404 | 2020-11-06 |
| 1265033088 | Palms Residential Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1500 Forest Ave Apt 13d, Portland, ME 04103-1846 | 2020-11-06 |
| 1104427160 | Kristine Lee Jones | Counselor | 2628 Se 87th Ave, Portland, OR 97266-1530 | 2020-11-05 |
| 1356942221 | Joseph Cody Brainard | Physical Therapist | 4416 Ne Simpson St, Portland, OR 97218-1446 | 2020-11-05 |
| 1427659671 | Lindsay Marie Thomas | Doula | 4503 Se 66th Ave, Portland, OR 97206-4501 | 2020-11-04 |
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1063013373 | Ruth Tessema | Counselor | 2120 Ne 166th Dr, Portland, OR 97230-5558 | 2020-11-03 |
| 1598366064 | Felipe Gregorio Flores | Dentist | 107 Shorecliff Dr, Portland, TX 78374-1459 | 2020-11-02 |
| 1982204509 | Uchendu Ezra Iwuanyanwu | Occupational Therapy Assistant | 3550 S Bond Ave, Portland, OR 97239-4507 | 2020-11-01 |
| Find all providers in PORTLAND | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235747775 | Cordant Pharmacy Oregon, LLC | Pharmacy | 6135 Ne 80th Ave Ste A2, Portland, OR 97218-4033 | 2020-07-21 |
| 1578184909 | Capsule Portland LLC | Pharmacy | 416 Nw 12th Ave, Portland, OR 97209-2907 | 2020-04-27 |
| 1588291645 | Avita Drugs Oregon, LLC | Pharmacy | 2236 Se Belmont St Ste B, Portland, OR 97214-2817 | 2020-03-26 |
| 1649800186 | A & S Pharmacy LLC | Pharmacy | 1660 Wildcat Dr, Portland, TX 78374-2830 | 2020-01-23 |
| 1508337577 | Oregon Health & Science University | Pharmacy | 3303 Sw Bond Ave Rm 1090, Portland, OR 97239-4501 | 2018-12-17 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1538653654 | Division Pharmacy Inc. | Pharmacy | 10918 Se Division St, Portland, OR 97266-1259 | 2018-06-21 |
| 1659755593 | Portland Professional Pharmacy, LLC | Pharmacy | 11717 Ne Glisan St, Portland, OR 97220-2141 | 2015-07-09 |
| 1992194062 | Professionl Pharmacy | Pharmacy | 10000 Se Main St Ste 201, Portland, OR 97216-2448 | 2015-01-13 |
| 1932597978 | Pharmaca Integrative Pharmacy, Inc | Pharmacy | 240 Nw Lost Springs Terrace, Suite 36, Portland, OR 97229 | 2014-12-29 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.