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General NPI Number Information
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NPI Number | 1841606662
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Entity Type | Organization
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Legal Business Name | REDMOND LONG TERM CARE PHARMACY LLC
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 424 NW 5TH ST STE A
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City | REDMOND
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State | OR
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Zip | 97756-1627
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Country | US
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Telephone | 541-526-1771
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Fax | 541-504-5476
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Provider Business Mailing Address
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Address Line | 424 NW 5TH STREET SUITE A
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City | REDMOND
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State | OR
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Zip | 97756
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Country | US
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Telephone | 541-526-1771
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Fax | 541-504-5476
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Authorized Official
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Title or Position | OWNER/RPH
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Name | MIKE EDMONDSON
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Credential |
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Telephone | 541-526-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | IP0002253CS
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License Number State | OR
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