Healthcare Provider Details

I. General information

NPI: 1326158585
Provider Name (Legal Business Name): MALHEUR DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 A ST W
VALE OR
97918-1302
US

IV. Provider business mailing address

198 A ST W
VALE OR
97918-1302
US

V. Phone/Fax

Practice location:
  • Phone: 541-473-3333
  • Fax: 541-473-9689
Mailing address:
  • Phone: 541-473-3333
  • Fax: 541-473-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP-0000577-CS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberIP-0001182-CS
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberIP-0001182-CS
License Number StateOR

VIII. Authorized Official

Name: DR. JENNIFER L. TOLMAN
Title or Position: PHARMACIST
Credential: PHARM.D.
Phone: 541-473-3333