Provider Demographics
NPI:1326158585
Name:MALHEUR DRUG, INC
Entity Type:Organization
Organization Name:MALHEUR DRUG, INC
Other - Org Name:MALHEUR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:541-473-3333
Mailing Address - Street 1:198 A ST W
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:OR
Mailing Address - Zip Code:97918-1302
Mailing Address - Country:US
Mailing Address - Phone:541-473-3333
Mailing Address - Fax:541-473-9689
Practice Address - Street 1:198 A ST W
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918-1302
Practice Address - Country:US
Practice Address - Phone:541-473-3333
Practice Address - Fax:541-473-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0000577-CS3336C0003X
ORIP-0001182-CS3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130203Medicaid
3805263OtherNCPDP
OR1034600001Medicare NSC