Provider Demographics
NPI:1043321375
Name:MERCY SERVICES CORPORATION
Entity Type:Organization
Organization Name:MERCY SERVICES CORPORATION
Other - Org Name:PARKWAY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-677-2458
Mailing Address - Street 1:2475 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1596
Mailing Address - Country:US
Mailing Address - Phone:541-677-2300
Mailing Address - Fax:541-677-2301
Practice Address - Street 1:2475 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1596
Practice Address - Country:US
Practice Address - Phone:541-677-2300
Practice Address - Fax:541-677-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR161179-133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277-736Medicaid