Organization
REDMOND LONG TERM CARE PHARMACY LLC
Active
Other names
Redmond Long Term Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE EDMONDSON (OWNER/RPH)
(541) 526-1771
Entity
Organization
Contact information
Practice address
424 NW 5TH ST STE A, REDMOND, OR 97756-1627
(541) 526-1771
(541) 504-5476
Mailing address
424 NW 5TH STREET, SUITE A, REDMOND, OR 97756
(541) 526-1771
(541) 504-5476
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
IP0002253CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146400
PK
—
Enumeration date
07/02/2014
Last updated
07/02/2014
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