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General NPI Number Information
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NPI Number | 1306103429
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD MEDICAL SERVICE CORP
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 220 S. MAIN
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City | BOARDMAN
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State | OR
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Zip | 97818
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Country | US
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Telephone | 541-667-3746
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Fax | 541-667-3749
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Provider Business Mailing Address
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Address Line | 220 S. MAIN
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City | BOARDMAN
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State | OR
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Zip | 97818
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Country | US
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Telephone | 541-667-3746
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Fax | 541-667-3749
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | JOHN ADAMS
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Credential |
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Telephone | 541-667-3746
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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 | RP-0002702
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License Number State | OR
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