Provider Demographics
NPI:1437294808
Name:STANDIFORD INVESTMENTS LLC
Entity Type:Organization
Organization Name:STANDIFORD INVESTMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-271-3631
Mailing Address - Street 1:1409 HIGHWAY 101 S
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1605
Mailing Address - Country:US
Mailing Address - Phone:541-271-3631
Mailing Address - Fax:541-271-4855
Practice Address - Street 1:1409 HIGHWAY 101 S
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1605
Practice Address - Country:US
Practice Address - Phone:541-271-3631
Practice Address - Fax:541-271-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ORRP-0000475-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157444OtherPK
OR170953Medicaid