Provider Demographics
NPI:1033202759
Name:SALEM HOSPITAL
Entity Type:Organization
Organization Name:SALEM HOSPITAL
Other - Org Name:SALEM HOSPITAL CTR FOR OUTPATIENT MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-561-5652
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:COM PHARMACY
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-561-6740
Mailing Address - Fax:506-561-4786
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:COM PHARMACY
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-561-6740
Practice Address - Fax:506-561-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0001800CS3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277844Medicaid
3814642OtherNCPDP