Gresham Professional Pharmacy
Gresham Professional Pharmacy is a healthcare organization registered as Community/Retail Pharmacy in Gresham, OR, holding Type 2 (organization) NPI 1063401198 since 2005. The authorized official on file is David Moll, Ceo.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1063401198 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Gresham Professional Pharmacy |
| Practice address | 24076 SE STARK ST, SUITE 100, Gresham, OR, 97030 |
| Phone | 5034910117 |
| Fax | 5034892078 |
| Enumeration date | 2005-10-20 |
| Last updated in NPPES | 2008-10-21 |
Authorized official
| Name | David Moll |
|---|---|
| Title | Ceo |
| Phone | 5034910117 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 183500000X | Pharmacist | Secondary | 8305 | OR |
| 3336C0003X | Community/Retail Pharmacy | Primary | 002102 | OR |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 299911 | Medicaid | OR | — |
| 3815125 | Other | OR | NABP/NCPDP # |
Copy-ready billing details
Provider: Gresham Professional Pharmacy NPI: 1063401198 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 24076 SE STARK ST, SUITE 100, Gresham, OR, 97030
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1720070873 | Shammai Rockove | Individual | Urology Physician | Gresham, OR |
| 1043292311 | Clem Eischen | Individual | Physical Therapist | Gresham, OR |
| 1386619534 | Heather Odell | Individual | Orthopedic Physical Therapist | Gresham, OR |
| 1265407019 | Roya Mansouri | Individual | Otolaryngology Physician | Gresham, OR |
| 1649245499 | Roger Wobig | Individual | Otolaryngology Physician | Gresham, OR |
| 1104875053 | Mountainview Mri LLC | Organization | Physiological Laboratory | Gresham, OR |
| 1720028335 | Christy Buckman | Individual | Otolaryngology Physician | Gresham, OR |
| 1003914243 | Stark Street Plaza, LLC | Organization | Ambulatory Surgical Clinic/Center | Gresham, OR |
Verify this record
Cross-check NPI 1063401198 against the authoritative CMS record: view Gresham Professional Pharmacy on the official NPPES registry .
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. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Gresham Professional Pharmacy?
Who is the authorized official for Gresham Professional Pharmacy?
Source: CMS NPPES (public data). Snapshot 2026-07-10. Provider record last updated 2008-10-21.