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Organization
SOUTH SALEM APOTHECARY LLC
Active
Organization
SOUTH SALEM APOTHECARY LLC
Active
Other names
South Salem Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA COURTNEY (OWNER)
(503) 967-2405
Entity
Organization
Contact information
Practice address
990 COMMERCIAL ST SE, SALEM, OR 97302-4110
(503) 967-2405
(503) 217-7940
Mailing address
990 COMMERCIAL ST SE, SALEM, OR 97302-4110
(503) 967-2405
(503) 217-7940
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0002754CS
OR
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3844532
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/27/2012
Last updated
03/19/2013
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