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Organization
HOME TOWN DRUGS OF PRINEVILLE INC
Active
Organization
HOME TOWN DRUGS OF PRINEVILLE INC
Active
Other names
Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MENDAZONA (DIRECTOR)
(541) 325-1059
Entity
Organization
Contact information
Practice address
198 NE COMBS FLAT RD STE 100, PRINEVILLE, OR 97754-2563
(541) 447-4111
(541) 416-9570
Mailing address
198 NE COMBS FLAT RD STE 100, PRINEVILLE, OR 97754-2563
(541) 447-4111
(541) 416-9570
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
00430
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228749
—
OR
01
—
3804273
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/01/2007
Last updated
12/15/2020
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