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Organization
CENTRAL DRUG STORE INC.
Active
Organization
CENTRAL DRUG STORE INC.
Active
Other names
Black Oak Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SHANE HARRELL PHARMD (OWNER)
(360) 859-8659
Entity
Organization
Contact information
Practice address
2924 SISKIYOU BLVD STE 102, MEDFORD, OR 97504-8194
(541) 773-5356
(541) 770-2999
Mailing address
PO BOX B, ILWACO, WA 98624-0167
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Enumeration date
10/08/2024
Last updated
12/20/2025
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