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:
Map and Directions
Authorized official contact:
Name: Lichlyter, Timothy
Phone: (541) 773-5356

Health care specialties

SpecialtyCodeLicense #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 11 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 1780738138 NPPES
California MEDICAID 04255554XI
California Other 2077225
California MEDICAID 013524

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