Provider Demographics
NPI:1952615163
Name:RED CROSS UNITED DRUG, INC.
Entity Type:Organization
Organization Name:RED CROSS UNITED DRUG, INC.
Other - Org Name:OLIVE BRANCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BROWNE
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-963-5741
Mailing Address - Street 1:306 WEST NORTH ST.
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828
Mailing Address - Country:US
Mailing Address - Phone:541-426-7455
Mailing Address - Fax:541-426-7445
Practice Address - Street 1:306 WEST NORTH ST.
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828
Practice Address - Country:US
Practice Address - Phone:541-426-7455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED CROSS UNITED DRUG, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-29
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0002602-CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500625079Medicaid