Healthcare Provider Details

I. General information

NPI: 1952405664
Provider Name (Legal Business Name): DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA IRS/EOPC/EOTC/OSH/OSH-P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WESTGATE
PENDLETON OR
97801-9604
US

IV. Provider business mailing address

PO BOX 14900
SALEM OR
97309-5016
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-0810
  • Fax: 541-278-2209
Mailing address:
  • Phone: 509-945-9469
  • Fax: 503-947-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberIP 00000 CS
License Number StateOR

VIII. Authorized Official

Name: RUSSELL R. KITTRELL
Title or Position: IRS MANAGER
Credential:
Phone: 509-945-9440