=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821292707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME TOWN DRUGS OF ROSEBURG INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 12/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1813 W HARVARD AVE SUITE 210
-----------------------------------------------------
City | ROSEBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97471-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-229-1112
-----------------------------------------------------
Fax | 541-229-1112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1813 W HARVARD AVE SUITE 210
-----------------------------------------------------
City | ROSEBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97471-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-229-1112
-----------------------------------------------------
Fax | 541-229-1112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY SHANE HARRELL
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 360-859-8659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | RP0002408
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------