# SOUTH SALEM APOTHECARY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Salem Apothecary
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952358780
- **Authorized official:** DIANA COURTNEY R PH (OWNER)
- **Authorized official phone:** (503) 967-2407

## Contact information

- **Practice address:** 990 COMMERCIAL ST SE, SALEM, OR 97302-4110
- **Practice address phone:** (503) 967-2407
- **Practice address fax:** (503) 217-7940
- **Mailing address:** 990 COMMERCIAL ST SE, SALEM, OR 97302-4110
- **Mailing address phone:** (503) 967-2407
- **Mailing address fax:** (503) 217-7940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | RP0002199CS | OR | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 12/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 231440 | — | OR |
| 01 | — | 3841865 | OTHER ID NUMBER | — |