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Organization
JACKSONVILLE NATURAL HEALTH PHARMACY
Active
Organization
JACKSONVILLE NATURAL HEALTH PHARMACY
Active
Other names
Jacksonville Natural Health Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER FITZSIMONS FITZSIMONS (MANAGER)
(541) 419-1277
Entity
Organization
Contact information
Practice address
310 E CALIFORNIA ST, JACKSONVILLE, OR 97530-9414
(541) 702-2700
(541) 702-2704
Mailing address
PO BOX 610, JACKSONVILLE, OR 97530-0610
(541) 702-2700
(541) 702-2704
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002577-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3843720
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/25/2009
Last updated
11/25/2009
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