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NPI Code Detail

MEDICARE: ACHTERHOF HEALTHCARE PHARMACY, LLC

MEDICARE: ACHTERHOF HEALTHCARE PHARMACY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care PharmacyIP-0001218-CSOR
2332B00000XDurable Medical Equipment & Medical Supplies001218OR
3333600000XPharmacy001218OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225022841
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACHTERHOF HEALTHCARE PHARMACY, LLC
Provider Business Mailing Address
First Line : PO BOX 2767
Second Line :
City : EUGENE
State : OR
Zip : 97402-0308
Country : US
Telephone Number : 541-744-1641
Fax Number :
Provider Business Practice Location Address
First Line : 1750 WILLOW CREEK CIR
Second Line :
City : EUGENE
State : OR
Zip : 97402-9152
Country : US
Telephone Number : 541-744-1641
Fax Number :
Authorized Official
Title or Position : OPERATIONS MANAGER
Name : RANDALL SCOTT KLEMM
Credential : RPH
Telephone Number : 541-744-1641
Provider Enumeration Date : 09/09/2005
Last Update Date : 01/27/2016

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Directions to “ACHTERHOF HEALTHCARE PHARMACY, LLC ” Practice Location

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