Organization
SISKIYOU COMMUNITY HEALTH CENTER, INC
Active
Parent organization
SISKIYOU COMMUNITY HEALTH CENTER INC
Other names
Siskiyou Community Health Center Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
SISKIYOU COMMUNITY HEALTH CENTER INC
Authorized official
RICHARD BOOTH (CEO)
(541) 471-3455
Entity
Organization
Contact information
Practice address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1257
(541) 472-4747
(541) 472-4786
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1257
(541) 471-3455
(541) 471-9242
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
RP0002572CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127725
—
OR
01
—
2122472
PK
—
05
—
500614374
—
OR
Enumeration date
10/21/2009
Last updated
10/06/2021
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