# CENTRAL DRUG STORE INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Black Oak Pharmacy LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124847074
- **Authorized official:** JEFFREY SHANE HARRELL PHARMD (OWNER)
- **Authorized official phone:** (360) 859-8659

## Contact information

- **Practice address:** 2924 SISKIYOU BLVD STE 102, MEDFORD, OR 97504-8194
- **Practice address phone:** (541) 773-5356
- **Practice address fax:** (541) 770-2999
- **Mailing address:** PO BOX B, ILWACO, WA 98624-0167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/08/2024
- **Last updated:** 12/20/2025