# DAVID JORGENSEN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Everetts Villa Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154433167
- **Authorized official:** DAVID JORGENSEN (OWNER)
- **Authorized official phone:** (541) 343-8861

## Contact information

- **Practice address:** 1755 COBURG RD, EUGENE, OR 97401
- **Practice address phone:** (541) 343-8861
- **Practice address fax:** (541) 465-1392
- **Mailing address:** 1755 COBURG RD, EUGENE, OR 97401
- **Mailing address phone:** (541) 343-8861
- **Mailing address fax:** (541) 465-1392

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 00182 | OR | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 00182 | OR | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |
| 3336M0002X | Mail Order Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1180250001 | DMERC | — |
| 05 | — | 170922 | — | OR |
| 01 | — | 3801657 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |