1902073471 NPI number — CURTIS PHARMACY INC.

Table of content: (NPI 1902073471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902073471 NPI number — CURTIS PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURTIS PHARMACY 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:
1902073471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 N. 3RD ST.
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-995-9711
Provider Business Mailing Address Fax Number:
541-995-9226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 N. 3RD ST.
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-995-9711
Provider Business Practice Location Address Fax Number:
541-995-9226
Provider Enumeration Date:
05/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
541-995-9711

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  001804 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: RP-0001804-CS , 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: 500738588 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".