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General NPI Number Information
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NPI Number | 1982022000
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Entity Type | Organization
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Legal Business Name | MIKES MERCANTILE CO
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 722 W HIGHWAY 20
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City | TOLEDO
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State | OR
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Zip | 97391-1128
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Country | US
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Telephone | 541-336-2261
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Fax |
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Provider Business Mailing Address
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Address Line | 722 W HIGHWAY 20
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City | TOLEDO
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State | OR
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Zip | 97391-1128
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Country | US
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Telephone | 541-336-2261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE ALLEN KNIGHT
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Credential | RPH
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Telephone | 541-336-2261
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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 | RP-0002912-CS
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License Number State | OR
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