Provider Demographics
NPI:1831295120
Name:TIFFANY-DAVIS DRUG CO.
Entity Type:Organization
Organization Name:TIFFANY-DAVIS DRUG CO.
Other - Org Name:TIFFANY'S DRUG #25 (BI-MART PHARMACY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-342-2148
Mailing Address - Street 1:960 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3106
Mailing Address - Country:US
Mailing Address - Phone:541-342-2148
Mailing Address - Fax:541-686-8305
Practice Address - Street 1:4310 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-8832
Practice Address - Country:US
Practice Address - Phone:541-997-3099
Practice Address - Fax:541-997-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNPA-0007078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135751Medicaid
3812319OtherNABP