Provider Demographics
NPI:1003685819
Name:ACHTERHOF HEALTHCARE PHARMACY, LLC
Entity Type:Organization
Organization Name:ACHTERHOF HEALTHCARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-744-1641
Mailing Address - Street 1:PO BOX 2767
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0308
Mailing Address - Country:US
Mailing Address - Phone:541-744-1641
Mailing Address - Fax:541-744-1052
Practice Address - Street 1:3120 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8450
Practice Address - Country:US
Practice Address - Phone:866-367-8701
Practice Address - Fax:866-367-8702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACHTERHOF HEALTHCARE PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy