Provider Demographics
NPI:1588658439
Name:ONTARIO PHARMACY INC
Entity Type:Organization
Organization Name:ONTARIO PHARMACY INC
Other - Org Name:DBA VALLEY COMPOUNDING PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-889-8087
Mailing Address - Street 1:925 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2124
Mailing Address - Country:US
Mailing Address - Phone:541-889-8174
Mailing Address - Fax:
Practice Address - Street 1:925 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2124
Practice Address - Country:US
Practice Address - Phone:541-889-8174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-OOOO347-CS183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR144808Medicaid
ID003355000Medicaid
3803132OtherNABP#
3803132OtherNABP#
AA1621045OtherDEA #
0243160001Medicare NSC