# OUTDOOR WORLD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SERVICE DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851473656
- **Authorized official:** DEBBIE CANTIELLO BS (BUSINESS MANAGER)
- **Authorized official phone:** (541) 476-8224

## Contact information

- **Practice address:** 1204 NW 6TH ST, GRANTS PASS, OR 97526-1254
- **Practice address phone:** (541) 476-8224
- **Practice address fax:** (541) 476-4132
- **Mailing address:** 1204 NW 6TH ST, GRANTS PASS, OR 97526-1254
- **Mailing address phone:** (541) 476-8224
- **Mailing address fax:** (541) 476-4132

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP-0000217 | OR | Yes |

## Other

- **Enumeration date:** 10/20/2006
- **Last updated:** 08/26/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 190751 | — | OR |
| 01 | — | 2077236 | PK | — |