=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871660357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERVINS DEVELOPMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 12/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 N MAIN ST
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97327-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-466-5112
-----------------------------------------------------
Fax | 541-466-5756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX B
-----------------------------------------------------
City | ILWACO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98624-0167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | RP0000140
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------