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General NPI Number Information
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NPI Number | 1851473656
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Entity Type | Organization
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Legal Business Name | OUTDOOR WORLD INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 1204 NW 6TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1254
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Country | US
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Telephone | 541-476-8224
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Fax | 541-476-4132
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Provider Business Mailing Address
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Address Line | 1204 NW 6TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1254
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Country | US
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Telephone | 541-476-8224
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Fax | 541-476-4132
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DEBBIE CANTIELLO
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Credential | BS
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Telephone | 541-476-8224
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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 | RP-0000217
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License Number State | OR
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