Organization
JACKSONVILLE NATURAL HEALTH PHARMACY
Active
Other names
Jacksonville Natural Health Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER FITZSIMONS FITZSIMONS (MANAGER)
(541) 419-1277
Entity
Organization
Contact information
Practice address
310 E CALIFORNIA ST, JACKSONVILLE, OR 97530-9414
(541) 702-2700
(541) 702-2704
Mailing address
PO BOX 610, JACKSONVILLE, OR 97530-0610
(541) 702-2700
(541) 702-2704
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
RP-0002577-CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3843720
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/25/2009
Last updated
11/25/2009
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