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Organization

HOME TOWN DRUGS OF PRINEVILLE INC

Active
Other names
Clinic Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL MENDAZONA (DIRECTOR)
(541) 325-1059
Entity
Organization

Contact information

Practice address
198 NE COMBS FLAT RD STE 100, PRINEVILLE, OR 97754-2563
(541) 447-4111
(541) 416-9570
Mailing address
198 NE COMBS FLAT RD STE 100, PRINEVILLE, OR 97754-2563
(541) 447-4111
(541) 416-9570

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0002X
Clinic Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
00430
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
228749
OR
01
3804273
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
03/01/2007
Last updated
12/15/2020
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