# BANDON PHARMACY

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

## Provider details

- **NPI number:** 1427197201
- **Authorized official:** DAVID SWENSON (OWNER)
- **Authorized official phone:** (503) 347-2222

## Contact information

- **Practice address:** 1225 OREGON AVE, BANDON, OR 97411-0369
- **Practice address phone:** (541) 347-2222
- **Practice address fax:** (541) 347-4241
- **Mailing address:** PO BOX 369, BANDON, OR 97411-0369

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP0000132 | OR | Yes |

## Other

- **Enumeration date:** 02/06/2007
- **Last updated:** 07/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 163063 | — | OR |
| 01 | — | 3807041 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |