Provider Demographics
NPI:1386632214
Name:ASHLAND DRUG INC.
Entity Type:Organization
Organization Name:ASHLAND DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:FIDEL
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-482-3366
Mailing Address - Street 1:53 N. SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-482-3366
Mailing Address - Fax:541-482-2736
Practice Address - Street 1:53 N. SECOND ST.
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-482-3366
Practice Address - Fax:541-482-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00111333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0380084-02OtherREGENCE HMO OREGON
OR170160Medicaid
OR816033000OtherREGENCE BLUE CROSS BLUE S
OR0799570001Medicare ID - Type Unspecified