Organization
SOUTH SALEM APOTHECARY LLC
Active
Other names
South Salem Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA COURTNEY (OWNER)
(503) 967-2405
Entity
Organization
Contact information
Practice address
990 COMMERCIAL ST SE, SALEM, OR 97302-4110
(503) 967-2405
(503) 217-7940
Mailing address
990 COMMERCIAL ST SE, SALEM, OR 97302-4110
(503) 967-2405
(503) 217-7940
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0002754CS
OR
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3844532
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/27/2012
Last updated
03/19/2013
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