Healthcare Provider Details

I. General information

NPI: 1134292956
Provider Name (Legal Business Name): SHERWILL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N.E. MAIN ST
WILLAMINA OR
97396
US

IV. Provider business mailing address

PO BOX 37
WILLAMINA OR
97396-0037
US

V. Phone/Fax

Practice location:
  • Phone: 503-876-8652
  • Fax: 503-876-2373
Mailing address:
  • Phone: 503-876-8652
  • Fax: 503-876-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberRP-0000580-CS
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRP-0000580-CS
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KAMAL A KOTAICH
Title or Position: OWNER
Credential: RPH
Phone: 503-876-8652