Healthcare Provider Details

I. General information

NPI: 1861773798
Provider Name (Legal Business Name): GRANTS PASS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 SW 6TH ST.
GRANTS PASS OR
97526-2810
US

IV. Provider business mailing address

414 SW 6TH ST.
GRANTS PASS OR
97526-2810
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-4262
  • Fax: 541-474-1443
Mailing address:
  • Phone: 541-476-4262
  • Fax: 541-474-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number0001164
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0001164
License Number StateOR

VIII. Authorized Official

Name: MS. MICHELE M BELCHER
Title or Position: VP OF OPERATIONS
Credential: RPH
Phone: 541-476-4262