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Gresham Professional Pharmacy

Community/Retail Pharmacy in Gresham, OR · enumerated 2005 · authorized official David Moll, Ceo.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1063401198

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Registry record

Entity type Organization (Type 2)
Legal business name Gresham Professional Pharmacy
Practice address 24076 Se Stark St, Suite 100, Gresham, OR, 97030
Phone (503) 491-0117
Fax (503) 489-2078
Enumeration date Oct 20, 2005
Last updated in NPPES Oct 21, 2008

Taxonomy & classification

183500000X Pharmacist Pharmacy Service Providers · License 8305 (OR) Secondary
3336C0003X Community/Retail Pharmacy Suppliers · License 002102 (OR) Primary

Authorized official

Name David Moll
Title Ceo
Phone (503) 491-0117

Other identifiers

Identifier Type State Issuer
299911 Medicaid OR -
3815125 Other OR NABP/NCPDP #

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Gresham Professional Pharmacy?
The NPI for Gresham Professional Pharmacy is 1063401198, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Gresham Professional Pharmacy?
NPPES lists David Moll (Ceo) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2008-10-21.