Provider Demographics
NPI:1114456563
Name:PHILIP KASER FAMILY, LLC
Entity Type:Organization
Organization Name:PHILIP KASER FAMILY, LLC
Other - Org Name:HARVARD AVENUE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-672-1961
Mailing Address - Street 1:1175 W HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2834
Mailing Address - Country:US
Mailing Address - Phone:541-672-1961
Mailing Address - Fax:541-672-9314
Practice Address - Street 1:1175 W. HARVARD AVENUE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-672-1961
Practice Address - Fax:541-672-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0000491-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR083105Medicaid