Organization
PEACEHEALTH MEDICAL GROUP
Active
Other names
PEACEHEALTH EMPLOYEE PHARMACY, PEACEHEALTH RIVERBEND OUTPATIENT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRENNAN DUANE BLACK PHARMD (PHARMACY MANAGER/PIC)
(541) 222-5800
Entity
Organization
Contact information
Practice address
3333 RIVERBEND DR, SPRINGFIELD, OR 97477-8800
(541) 222-5800
(541) 431-9149
Mailing address
3333 RIVERBEND DR, SPRINGFIELD, OR 97477-8800
(541) 222-5800
(541) 431-9149
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RP-0000785-CS
OR
3336C0003X
Community/Retail Pharmacy
Primary
PHAO1124
AK
3336S0011X
Specialty Pharmacy
PHNR.FO.60259219
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053967
—
OR
01
—
2077299
PK
—
Enumeration date
08/08/2006
Last updated
09/11/2023
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