# PEACEHEALTH MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PEACEHEALTH EMPLOYEE PHARMACY, PEACEHEALTH RIVERBEND OUTPATIENT PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922018639
- **Authorized official:** BRENNAN DUANE BLACK PHARMD (PHARMACY MANAGER/PIC)
- **Authorized official phone:** (541) 222-5800

## Contact information

- **Practice address:** 3333 RIVERBEND DR, SPRINGFIELD, OR 97477-8800
- **Practice address phone:** (541) 222-5800
- **Practice address fax:** (541) 431-9149
- **Mailing address:** 3333 RIVERBEND DR, SPRINGFIELD, OR 97477-8800
- **Mailing address phone:** (541) 222-5800
- **Mailing address fax:** (541) 431-9149

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | RP-0000785-CS | OR | — |
| 3336C0003X | Community/Retail Pharmacy | PHAO1124 | AK | Yes |
| 3336S0011X | Specialty Pharmacy | PHNR.FO.60259219 | WA | — |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 09/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 053967 | — | OR |
| 01 | — | 2077299 | PK | — |