Organization
B L W INC
Active
Other names
Hometown Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MENDAZONA RPH (PRESIDENT)
(541) 475-2142
Entity
Organization
Contact information
Practice address
65 NE OAK ST STE 100, MADRAS, OR 97741-1814
(541) 475-2142
(541) 475-6244
Mailing address
65 NE OAK ST STE 100, MADRAS, OR 97741-1814
(541) 475-2142
(541) 475-6244
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP0000292CS
OR
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194373
—
OR
01
—
2077338
PK
—
05
—
293105
—
OR
Enumeration date
08/10/2006
Last updated
09/18/2021
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