Provider Demographics
NPI:1881654879
Name:JHSO CORPORATION
Entity Type:Organization
Organization Name:JHSO CORPORATION
Other - Org Name:HI-SCHOOL PHARMACY SILVERTON DRUGS#1178
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTACT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKESLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-213-2236
Mailing Address - Street 1:916 W EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3035
Mailing Address - Country:US
Mailing Address - Phone:360-213-2236
Mailing Address - Fax:360-213-2238
Practice Address - Street 1:406 MCCLAINE ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1921
Practice Address - Country:US
Practice Address - Phone:503-873-8391
Practice Address - Fax:503-873-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0001078CS332B00000X, 333600000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR127055Medicaid
3811468OtherNCPDP
3811468OtherNCPDP