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General NPI Number Information
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NPI Number | 1427197201
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Entity Type | Organization
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Legal Business Name | BANDON PHARMACY
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1225 OREGON AVE
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City | BANDON
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State | OR
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Zip | 97411-0369
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Country | US
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Telephone | 541-347-2222
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Fax | 541-347-4241
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Provider Business Mailing Address
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Address Line | PO BOX 369
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City | BANDON
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State | OR
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Zip | 97411-0369
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID SWENSON
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Credential |
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Telephone | 503-347-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP0000132
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License Number State | OR
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