Organization
MOSAIC MEDICAL
Active
Parent organization
MOSAIC MEDICAL
Other names
Mosaic Pharmacy-Madras
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOSAIC MEDICAL
Authorized official
BOBBI JOLYNE SURPLUS (REVENUE CYCLE MANAGER)
(541) 408-9486
Entity
Organization
Contact information
Practice address
500 NE A ST STE 101, MADRAS, OR 97741-1842
(541) 383-3005
(541) 383-1883
Mailing address
600 SW COLUMBIA ST STE 6150, BEND, OR 97702-1099
(541) 383-3005
(541) 383-1883
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003755
PHARMACY BOARD
OR
Enumeration date
01/14/2022
Last updated
01/14/2022
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