Healthcare Provider Details

I. General information

NPI: 1225022841
Provider Name (Legal Business Name): ACHTERHOF HEALTHCARE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 WILLOW CREEK CIR
EUGENE OR
97402-9152
US

IV. Provider business mailing address

PO BOX 2767
EUGENE OR
97402-0308
US

V. Phone/Fax

Practice location:
  • Phone: 541-744-1641
  • Fax:
Mailing address:
  • Phone: 541-744-1641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number001218
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number001218
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberIP-0001218-CS
License Number StateOR

VIII. Authorized Official

Name: RANDALL SCOTT KLEMM
Title or Position: OPERATIONS MANAGER
Credential: RPH
Phone: 541-744-1641