# CENTRAL DRUG STORE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BLACK OAK PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780738138
- **Authorized official:** JEFFREY HARRELL (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 |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0000767 | OR | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 12/22/2025