Provider Demographics
NPI:1871644799
Name:SHINDLER'S DRUGSTORE INC.
Entity Type:Organization
Organization Name:SHINDLER'S DRUGSTORE INC.
Other - Org Name:SHINDLER'S HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RYCE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-347-3707
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:215 10TH ST S.E.
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-0069
Mailing Address - Country:US
Mailing Address - Phone:541-347-3707
Mailing Address - Fax:541-347-3158
Practice Address - Street 1:215 10TH ST S.E.
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-0069
Practice Address - Country:US
Practice Address - Phone:541-347-3707
Practice Address - Fax:541-347-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR001313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3800960OtherNABP
OR182956Medicaid
OR182956Medicaid