Organization
SISKIYOU COMMUNITY HEALTH CENTER PHARMACY
Active
Parent organization
SISKIYOU COMMUNITY HEALTH CENTER INC
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) 471-3455
(541) 471-9242
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1257
(541) 471-3455
(541) 471-9242
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002572-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500711967
—
OR
Enumeration date
04/29/2016
Last updated
10/06/2021
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