Black Oak Pharmacy
LBN: Central Drug Store Inc
Black Oak Pharmacy is an health care organization with primary practice located at 2924 Siskiyou Blvd Ste 102, Medford OR 97504-8194. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Central Drug Store Inc can be contacted via phone (541) 773-5356, or through Lichlyter, Timothy via phone (541) 773-5356.
Contact Information
Primary practice address
2924 Siskiyou Blvd Ste 102
Medford OR 97504-8194
Phone: (541) 773-5356
Fax: (541) 770-2999
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
Suppliers / Pharmacy | 333600000X | ||
Suppliers / Community/Retail Pharmacy | 3336C0003X | RP-0000767 | Oregon |
Suppliers / Compounding Pharmacy | 3336C0004X |
Profile Details
NPI number | 1780738138 |
---|---|
LBN Legal business name | Central Drug Store Inc |
DBA Doing business as | Black Oak Pharmacy |
Authorized official | Lichlyter, Timothy |
Entity | Organization |
Organization subpart 1 | No |
Enumeration date | Jan 23rd, 2007 |
Last updated | Aug 26th, 2013 - about 12 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 | 1780738138 | NPPES |
California | MEDICAID | 04255554XI | |
California | Other | 2077225 | |
California | MEDICAID | 013524 |
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