Organization
CENTRAL DRUG STORE INC
Active
Other names
BLACK OAK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY HARRELL (OWNER)
(360) 859-8659
Entity
Organization
Contact information
Practice address
2924 SISKIYOU BLVD, STE 102, MEDFORD, OR 97504-8194
(541) 773-5356
(541) 770-2999
Mailing address
PO BOX B, ILWACO, WA 98624-0167
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0000767
OR
Other
Enumeration date
01/23/2007
Last updated
12/22/2025
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