# REDMOND LONG TERM CARE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Redmond Long Term Care Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841606662
- **Authorized official:** MIKE EDMONDSON (OWNER/RPH)
- **Authorized official phone:** (541) 526-1771

## Contact information

- **Practice address:** 424 NW 5TH ST STE A, REDMOND, OR 97756-1627
- **Practice address phone:** (541) 526-1771
- **Practice address fax:** (541) 504-5476
- **Mailing address:** 424 NW 5TH STREET, SUITE A, REDMOND, OR 97756
- **Mailing address phone:** (541) 526-1771
- **Mailing address fax:** (541) 504-5476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | IP0002253CS | OR | Yes |

## Other

- **Enumeration date:** 07/02/2014
- **Last updated:** 07/02/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2146400 | PK | — |