Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gresham Professional Pharmacy

Organization Pharmacist · NPI 1063401198

Gresham Professional Pharmacy is a Pharmacist 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
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