Organization
CENTRAL DRUG STORE INC.
Active
Other names
Black Oak Pharmacy LTC
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SHANE HARRELL PHARMD (OWNER)
(360) 859-8659
Entity
Organization
Contact information
Practice address
2924 SISKIYOU BLVD STE 102, MEDFORD, OR 97504-8194
(541) 773-5356
(541) 770-2999
Mailing address
PO BOX B, ILWACO, WA 98624-0167
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
10/08/2024
Last updated
12/20/2025
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