# GOOD SHEPHERD MEDICAL SERVICE CORP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** GOOD SHEPHERD BOARDMAN PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306103429
- **Authorized official:** JOHN ADAMS (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (541) 667-3746

## Contact information

- **Practice address:** 220 S. MAIN, BOARDMAN, OR 97818
- **Practice address phone:** (541) 667-3746
- **Practice address fax:** (541) 667-3749
- **Mailing address:** 220 S. MAIN, BOARDMAN, OR 97818
- **Mailing address phone:** (541) 667-3746
- **Mailing address fax:** (541) 667-3749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP-0002702 | OR | Yes |

## Other

- **Enumeration date:** 04/13/2012
- **Last updated:** 09/30/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2134514 | PK | — |