Healthcare Provider Details

I. General information

NPI: 1154433167
Provider Name (Legal Business Name): DAVID JORGENSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 COBURG RD
EUGENE OR
97401
US

IV. Provider business mailing address

1755 COBURG RD
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-8861
  • Fax: 541-465-1392
Mailing address:
  • Phone: 541-343-8861
  • Fax: 541-465-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00182
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00182
License Number StateOR

VIII. Authorized Official

Name: DAVID JORGENSEN
Title or Position: OWNER
Credential:
Phone: 541-343-8861