Provider Demographics
NPI:1619735925
Name:ST. CHARLES HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:ST. CHARLES HEALTH SYSTEM, INC.
Other - Org Name:ST CHARLES SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-706-7707
Mailing Address - Street 1:2500 NE NEFF RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6015
Mailing Address - Country:US
Mailing Address - Phone:541-706-3238
Mailing Address - Fax:541-598-3488
Practice Address - Street 1:62968 LAYTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8763
Practice Address - Country:US
Practice Address - Phone:541-706-3238
Practice Address - Fax:541-598-3488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CHARLES HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy