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
Phone: (541) 878-3151
Fax: (541) 878-8228
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790830446 | NPPES |
| Other | 3810339 | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| MEDICAID | 009584 | NCPDP PROVIDER IDENTIFICATION NUMBER |
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