Provider Demographics
NPI:1255462180
Name:WHEELER PHARMACY INC
Entity type:Organization
Organization Name:WHEELER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-368-5783
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:OR
Mailing Address - Zip Code:97147-0067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 NEHALEM BLVD
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:OR
Practice Address - Zip Code:97147
Practice Address - Country:US
Practice Address - Phone:503-368-5783
Practice Address - Fax:503-368-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ORRP0000582CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3805364OtherOTHER ID NUMBER
OR216655Medicaid
3805364OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3805364OtherOTHER ID NUMBER