1386632214 NPI number — ASHLAND DRUG INC.

Table of content: (NPI 1386632214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386632214 NPI number — ASHLAND DRUG INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHLAND DRUG INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386632214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 N. SECOND ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-482-3366
Provider Business Mailing Address Fax Number:
541-482-2736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 N. SECOND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-482-3366
Provider Business Practice Location Address Fax Number:
541-482-2736
Provider Enumeration Date:
10/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
FIDEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-482-3366

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  00111 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0380084-02 . This is a "REGENCE HMO OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 170160 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 816033000 . This is a "REGENCE BLUE CROSS BLUE S" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".