Organization
SOUTH SALEM APOTHECARY, LLC
Active
Other names
South Salem Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA COURTNEY R PH (OWNER)
(503) 967-2407
Entity
Organization
Contact information
Practice address
990 COMMERCIAL ST SE, SALEM, OR 97302-4110
(503) 967-2407
(503) 217-7940
Mailing address
990 COMMERCIAL ST SE, SALEM, OR 97302-4110
(503) 967-2407
(503) 217-7940
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RP0002199CS
OR
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231440
—
OR
01
—
3841865
OTHER ID NUMBER
—
Enumeration date
05/27/2006
Last updated
12/18/2012
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