Organization
OUTDOOR WORLD INC
Active
Other names
SERVICE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE CANTIELLO BS (BUSINESS MANAGER)
(541) 476-8224
Entity
Organization
Contact information
Practice address
1204 NW 6TH ST, GRANTS PASS, OR 97526-1254
(541) 476-8224
(541) 476-4132
Mailing address
1204 NW 6TH ST, GRANTS PASS, OR 97526-1254
(541) 476-8224
(541) 476-4132
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0000217
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190751
—
OR
01
—
2077236
PK
—
Enumeration date
10/20/2006
Last updated
08/26/2013
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