Healthcare Provider Details

I. General information

NPI: 1023483823
Provider Name (Legal Business Name): CENTRAL OREGON PHARMACY AND COMPOUNDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 NW GREENWOOD AVE STE 1
REDMOND OR
97756-1672
US

IV. Provider business mailing address

655 NW GREENWOOD AVE STE 1
REDMOND OR
97756-1672
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-1066
  • Fax: 541-548-1067
Mailing address:
  • Phone: 541-548-1066
  • Fax: 541-548-1067

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 NumberRP-0003153-CS
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN COOPER
Title or Position: OWNER-PHARMACIST
Credential:
Phone: 541-548-1066