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General NPI Number Information
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NPI Number | 1043321375
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Entity Type | Organization
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Legal Business Name | MERCY SERVICES CORPORATION
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 2475 NW STEWART PKWY
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City | ROSEBURG
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State | OR
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Zip | 97470-1596
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Country | US
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Telephone | 541-677-2300
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Fax | 541-677-2301
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Provider Business Mailing Address
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Address Line | 2475 NW STEWART PKWY
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City | ROSEBURG
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State | OR
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Zip | 97471-1596
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Country | US
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Telephone | 541-677-2300
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Fax | 541-677-2301
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Authorized Official
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Title or Position | VICE PRESIDENT/CFO
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Name | JOHN S. KASBERGER
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Credential |
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Telephone | 541-677-2458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 161179-13
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License Number State | OR
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