Shady Cove Pharmacy

LBN: Central Drug Store Inc
Shady Cove Pharmacy is an health care organization with primary practice located at 21195 Hwy 62 , Shady Cove OR 97539-9715. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Central Drug Store Inc can be contacted via phone (541) 878-3151, or through Lichlyter, Timothy via phone (541) 494-2616.

Contact Information

Primary practice address
21195 Hwy 62 Shady Cove OR 97539-9715
Fax: (541) 878-8228
Website:
Authorized official contact:
Name: Lichlyter, Timothy

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X RP0000715CS Oregon

Profile Details

NPI number 1790830446
LBN Legal business name Central Drug Store Inc
DBA Doing business as Shady Cove Pharmacy
Authorized official Lichlyter, Timothy
Entity Organization
Organization subpart 1 No
Enumeration date Jan 24th, 2007
Last updated Aug 25th, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790830446 NPPES
Other 3810339 NCPDP PROVIDER IDENTIFICATION NUMBER
MEDICAID 009584 NCPDP PROVIDER IDENTIFICATION NUMBER

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