Organization
SISKIYOU COMMUNITY HEALTH CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BOOTH (CEO)
(541) 471-3455
Entity
Organization
Contact information
Practice address
25647 REDWOOD HWY, CAVE JUNCTION, OR 97523-9332
(541) 592-4111
(541) 592-3916
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1257
(541) 471-3455
(541) 471-9242
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
RP-0003008-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679920
—
OR
Enumeration date
11/05/2014
Last updated
10/06/2021
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