Provider Demographics
NPI:1902849268
Name:RED CROSS UNITED DRUG INC
Entity Type:Organization
Organization Name:RED CROSS UNITED DRUG INC
Other - Org Name:RED CROSS INSTITUTIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-963-5741
Mailing Address - Street 1:1123 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2692
Mailing Address - Country:US
Mailing Address - Phone:541-963-5741
Mailing Address - Fax:541-963-6332
Practice Address - Street 1:206 DEPOT ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2619
Practice Address - Country:US
Practice Address - Phone:541-963-5741
Practice Address - Fax:541-963-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
ORRP-0003206-CS3336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2079232OtherPK
OR183013Medicaid
2079232OtherPK
R149038Medicare PIN