Organization
DAVID JORGENSEN
Active
Other names
Everetts Villa Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID JORGENSEN (OWNER)
(541) 343-8861
Entity
Organization
Contact information
Practice address
1755 COBURG RD, EUGENE, OR 97401
(541) 343-8861
(541) 465-1392
Mailing address
1755 COBURG RD, EUGENE, OR 97401
(541) 343-8861
(541) 465-1392
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
00182
OR
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00182
OR
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1180250001
DMERC
—
05
—
170922
—
OR
01
—
3801657
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/31/2006
Last updated
03/07/2023
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