Provider Demographics
NPI:1972265411
Name:DAHISSE INC
Entity Type:Organization
Organization Name:DAHISSE INC
Other - Org Name:MYRTLE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:360-244-5984
Mailing Address - Street 1:821 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-9334
Mailing Address - Country:US
Mailing Address - Phone:541-391-8321
Mailing Address - Fax:541-391-8381
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9334
Practice Address - Country:US
Practice Address - Phone:541-391-8321
Practice Address - Fax:541-391-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy