Organization
ALBANY GENERAL HOSPITAL
Active
Other names
Elm Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID TRIEBES MBA (CEO)
(541) 812-4102
Entity
Organization
Contact information
Practice address
1010 7TH AVE SW, ALBANY, OR 97321-1922
(541) 812-5071
Mailing address
1010 7TH AVE SW, ALBANY, OR 97321-1922
(541) 812-5071
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00104
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP-0000104-CS
STATE LICENSE
OR
Enumeration date
01/18/2007
Last updated
11/21/2018
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