Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Gresham Professional Pharmacy

Organization Pharmacist · NPI 1063401198

Gresham Professional Pharmacy provides Pharmacist services in Gresham, Oregon. Licensed in Oregon. Registered with an NPI since 2005.

Licensed in
OR
In the registry since
2005
Specialties on file
2

Practice location Address checks out

24076 SE Stark St Ste 100
Gresham, OR 97030-3373 Not confirmed with CMS for 17 years — call before visiting
Phone: (503) 491-0117
Fax: (503) 489-2078
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence 002102 (OR)
Pharmacist Taxonomy 183500000X · Licence 8305 (OR)

Record details

NPI number1063401198
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official David Moll — Ceo · (503) 491-0117
NPI enumeratedOctober 20, 2005
Last updated in NPPESOctober 21, 2008
Mailing address24076 Se Stark St, Suite 100, Gresham, OR 97030-3373

Other providers in Gresham