Healthcare Provider Details

I. General information

NPI: 1366507782
Provider Name (Legal Business Name): DRUG MART PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51600 HUNTINGTON RD STE A
LA PINE OR
97739-8887
US

IV. Provider business mailing address

PO BOX 159
LA PINE OR
97739-0159
US

V. Phone/Fax

Practice location:
  • Phone: 541-536-1111
  • Fax: 541-536-1980
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0001239
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDON SANDOVAL
Title or Position: OWNER
Credential:
Phone: 541-536-1111