Provider Demographics
NPI:1942257043
Name:SENIOR PHARMACY, LLC
Entity Type:Organization
Organization Name:SENIOR PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-607-2000
Mailing Address - Street 1:28717 GRUMMAN DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9542
Mailing Address - Country:US
Mailing Address - Phone:541-607-2000
Mailing Address - Fax:541-284-8232
Practice Address - Street 1:28717 GRUMMAN DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9542
Practice Address - Country:US
Practice Address - Phone:541-607-2000
Practice Address - Fax:541-284-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002006-CS310400000X
ORIP-0001818-CS314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3814034OtherNCPDP
OR227136Medicaid
OR227137Medicaid
OR227137Medicaid
OR227137Medicaid