Organization
PHOENIX DOWNTOWN PHARMACY LLC
Active
Other names
Phoenix Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN EGENDOERFER (OWNER)
(541) 301-1473
Entity
Organization
Contact information
Practice address
404 N MAIN ST, PHOENIX, OR 97535-9632
(541) 535-1561
(541) 535-3015
Mailing address
PO BOX 817, PHOENIX, OR 97535-0817
(541) 301-1473
(503) 549-8717
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0000299-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140394
PK
—
Enumeration date
11/29/2005
Last updated
05/06/2014
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