Provider Demographics
NPI:1952395733
Name:ONTARIO PHARMACY INC
Entity Type:Organization
Organization Name:ONTARIO PHARMACY INC
Other - Org Name:DBA APPLETREE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-889-8174
Mailing Address - Street 1:555 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2643
Mailing Address - Country:US
Mailing Address - Phone:541-889-2775
Mailing Address - Fax:
Practice Address - Street 1:555 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2643
Practice Address - Country:US
Practice Address - Phone:541-889-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0002220-CS183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3842019OtherNABP#
ID8071295000Medicaid
BA9048213OtherDEA#
ID8071295000Medicaid