1. Home
  2. Directory
  3. Oregon
  4. Gresham
  5. Pharmacy
  6. NPI Profile

GRESHAM PROFESSIONAL PHARMACY
NPI 1063401198
Pharmacy - Community/Retail Pharmacy in Gresham, OR

Active since October 20, 2005
24076 SE STARK ST, SUITE 100, GRESHAM, OR 97030(503) 491-0117(503) 489-2078 Get Directions Write a Review

NPPES record last updated: October 21, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Gresham Professional Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRESHAM PROFESSIONAL PHARMACY (NPI 1063401198) is a healthcare organization registered as a community/retail pharmacy in Gresham, Oregon and active in the NPI registry since October 2005. The organization lists David G Moll, Ceo, as its authorized official.

NPPES Registry Identity

NPI1063401198
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameGRESHAM PROFESSIONAL PHARMACY
Location Address24076 SE STARK ST, SUITE 100Gresham, OR 97030-3373
Mailing Address24076 Se Stark St, Suite 100Gresham, OR 97030-3373 · (503) 491-0117 · Fax (503) 489-2078
Phone(503) 491-0117
Fax(503) 489-2078
Organization SubpartNo
Authorized OfficialDavid G MollCeo · (503) 491-0117
Enumeration DateOctober 20, 2005
Last NPPES UpdateOctober 21, 2008
✔ NPI 1063401198 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in OR · 002102
Definition
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.
Also ListedPharmacistTaxonomy 183500000X · License 8305 (OR)
24076 SE STARK ST, Gresham, OR 97030
Open in Google Maps ↗

Other Identifiers 2

Medicaid299911OR
Other3815125OR · Nabp/ncpdp #

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STARK STREET PLAZA, LLC
Clinic/Center (Ambulatory Surgical)
24076 SE STARK ST, SUITE 310
GRESHAM, OR 97030
Multnomah County (503) 492-6510
CENTER FOR MENS AND WOMENS UROLOGY LLC
Specialist
24076 SE STARK ST, SUITE 310
GRESHAM, OR 97030
Multnomah County (503) 492-6510
MR. CLEM GEORGE EISCHEN JR. PT
Physical Therapist
24076 SE STARK ST
GRESHAM, OR 97030
Multnomah County (503) 491-1666
MOUNTAINVIEW MRI LLC
Physiological Laboratory
24076 SE STARK ST, SUITE 180
GRESHAM, OR 97030
Multnomah County (503) 661-6500
DR. BOBAK AMIR GHAHERI M.D.
Otolaryngology
24076 SE STARK ST, SUITE 230
GRESHAM, OR 97030
Multnomah County (503) 488-2600
ANNA LEE PAC
Physician Assistant
24076 SE STARK ST, SUITE 230
GRESHAM, OR 97030
Multnomah County (503) 488-2600
GREGORY GULLO MD PC
Anesthesiology (Pain Medicine)
24076 SE STARK ST, SUITE 320
GRESHAM, OR 97030
Multnomah County (503) 512-1212
GLEN A MILLIGAN M.D.
Specialist
24076 SE STARK ST, SUITE 230
GRESHAM, OR 97030
Multnomah County (503) 465-5461

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gresham Professional Pharmacy's NPI number?

The NPI number for Gresham Professional Pharmacy is 1063401198. It was assigned to this organization in the NPPES registry on October 20, 2005.

Where is Gresham Professional Pharmacy located?

Gresham Professional Pharmacy is located at 24076 SE Stark St Suite 100, Gresham, OR 97030. The listed phone number is (503) 491-0117.

What is Gresham Professional Pharmacy's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

When was this NPI record last updated?

The NPPES record for Gresham Professional Pharmacy was last updated on October 21, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.