# EDEN HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194317909
- **Authorized official:** DR. DANE FICKES PHARMD (OWNER)
- **Authorized official phone:** (541) 329-0478

## Contact information

- **Practice address:** 843 E MAIN ST STE 204, MEDFORD, OR 97504-7137
- **Practice address phone:** (541) 329-0478
- **Practice address fax:** (541) 314-9556
- **Mailing address:** 843 E MAIN ST STE 204, MEDFORD, OR 97504-7137
- **Mailing address phone:** (541) 329-0478
- **Mailing address fax:** (541) 314-9556

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 02/03/2021
- **Last updated:** 07/25/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | RP-0003659 | OREGON BOARD OF PHARMACY RETAIL DRUG OUTLET LICENSE | OR |