MEDFORD PHARMACY GROUP LLC (NPI# 1780781625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780781625 |
| Entity Type | Organization |
| Organization Name | MEDFORD PHARMACY GROUP LLC |
| Other Organization Name | WEST MAIN PHARMACY |
| Practice Address |
2355 W Main St Medford OR 97501 |
| Mailing Address |
Po Box B Ilwaco WA 98624 |
| Practice Telephone | 5417722330 |
| Practice Fax Number | 5417724852 |
| Mailing Telephone | 3606423133 |
| Mailing Fax Number | 3606425133 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-26 |
| Authorized Official Name | JEFFREY S HARRELL (OWNER) |
| Authorized Official Telephone | 3602445984 |
| Authorized Official Credential | PHARM D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
RP0000291CS | OR | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146390 | 01 |
| Other Name | Type Code |
|---|---|
| WEST MAIN DRUG | Doing Business As Name - Organization |
| West Main Pharmacy | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | MEDFORD PHARMACY GROUP LLC | 101 1st Ave S, Ilwaco, WA 98624-9100 |
| Oregon Corporations, Companies and Business Names | MEDFORD PHARMACY GROUP LLC | 2355 W Main St, Medford, OR 97501 |
| Street Address |
2355 W MAIN ST |
| City | MEDFORD |
| State | OR |
| Zip Code | 97501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942674676 | West Main Pharmacy | Pharmacy | 2355 W Main St, Medford, OR 97501-2161 | 2015-11-18 |
| 1710250717 | Marc Ditommaso | Pharmacist | 2355 W Main St, Medford, OR 97501-2161 | 2012-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366069494 | Brian Snapp | Counselor | 1191 Hazel St, Medford, OR 97501 | 2020-07-06 |
| 1477174761 | Corey Renfree | Counselor | 1191 Hazel Street, Medford, OR 97501 | 2020-04-28 |
| 1669012928 | One of A Kind Therapy LLC | Social Worker | 916 West 10th St #205, Medford, OR 97501 | 2020-01-14 |
| 1265993620 | Star Dialysis LLC | Clinic/Center | 50 Rossanley Dr, Medford, OR 97501 | 2019-03-28 |
| 1962972463 | Karen Elise Roertgen | Counselor | 328 So. Central Ave., Suite 204, Medford, OR 97501 | 2018-11-28 |
| 1316458813 | Rick's Medical Supply, Inc | Durable Medical Equipment & Medical Supplies | 562 Parsons Drive, Suite 114, Medford, OR 97501 | 2017-10-24 |
| 1750807111 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 821 N Riverside Ave, Medford, OR 97501 | 2017-08-17 |
| 1992229009 | Cassandra Schultz | Massage Therapist | 824 East Jackson, Suite A, Medford, OR 97501 | 2017-07-31 |
| 1972962355 | Robin Clevenger | Peer Specialist | 301 S Ivy St, Medford, OR 97501 | 2016-02-15 |
| 1154706984 | Debbie Diane Orr | Behavioral Analyst | 1024 West 9th Street, Medford, OR 97501 | 2015-07-22 |
| Find all providers in zip 97501 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083160147 | Safeway | Pharmacy | 2001 Table Rock Rd, Apt 28, Medford, OR 97501-1483 | 2016-08-29 |
| 1902168289 | Medford Family Pharmacy LLC | Pharmacy | 103 Old Marlton Pike Ste 123, Medford, NJ 08055-8772 | 2012-06-12 |
| 1205043387 | Walgreen Co | Pharmacy | 210 E Barnett Rd, Medford, OR 97501-7928 | 2007-05-17 |
| 1285717520 | New Jersey Cvs Pharmacy LLC | Pharmacy | 137 Route 70, Medford, NJ 08055-2378 | 2006-10-23 |
| 1598864944 | Cvs Pharmacy Inc | Pharmacy | 590 Fellsway, Medford, MA 02155-4925 | 2006-09-22 |
| 1124127576 | Cvs Pharmacy Inc | Pharmacy | 55 Riverside Ave, Medford, MA 02155-4605 | 2006-09-22 |
| 1669576427 | Cvs Albany LLC | Pharmacy | 1565 Route 112, Medford, NY 11763-3647 | 2006-09-12 |
| 1548375322 | Medford Shoprite, Inc. | Pharmacy | 208 Route 70, Medford, NJ 08055-9522 | 2006-08-20 |
| 1518998079 | Walgreen Co | Pharmacy | 49 Station Lndg, Medford, MA 02155-5192 | 2006-07-05 |
| 1376008664 | Genoa Healthcare, LLC | Pharmacy | 503 Airport Rd Ste 101, Medford, OR 97504-4159 | 2019-01-31 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.