Organization
EDEN HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANE FICKES PHARMD (OWNER)
(541) 329-0478
Entity
Organization
Contact information
Practice address
843 E MAIN ST STE 204, MEDFORD, OR 97504-7137
(541) 329-0478
(541) 314-9556
Mailing address
843 E MAIN ST STE 204, MEDFORD, OR 97504-7137
(541) 329-0478
(541) 314-9556
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP-0003659
OREGON BOARD OF PHARMACY RETAIL DRUG OUTLET LICENSE
OR
Enumeration date
02/03/2021
Last updated
07/25/2021
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