Provider Demographics
NPI:1649719287
Name:TEAMSTER LOCAL 670, HEALTH DIV., CANNERY DIST. CO. INC
Entity type:Organization
Organization Name:TEAMSTER LOCAL 670, HEALTH DIV., CANNERY DIST. CO. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-581-3419
Mailing Address - Street 1:750 BROWNING AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3806
Mailing Address - Country:US
Mailing Address - Phone:503-581-3419
Mailing Address - Fax:503-581-1134
Practice Address - Street 1:750 BROWNING AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3806
Practice Address - Country:US
Practice Address - Phone:503-581-3419
Practice Address - Fax:503-581-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR333600000X3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy