Provider Demographics
NPI:1134292956
Name:SHERWILL, INC
Entity Type:Organization
Organization Name:SHERWILL, INC
Other - Org Name:WILLAMINA DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOTAICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-876-8652
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-0037
Mailing Address - Country:US
Mailing Address - Phone:503-876-8652
Mailing Address - Fax:503-876-2373
Practice Address - Street 1:212 N.E. MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLAMINA
Practice Address - State:OR
Practice Address - Zip Code:97396
Practice Address - Country:US
Practice Address - Phone:503-876-8652
Practice Address - Fax:503-876-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0000580-CS332B00000X, 333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR169708Medicaid
OR169708Medicaid