South Salem Apothecary LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP0002754CS Issued in OR

Legal business name

SOUTH SALEM APOTHECARY LLC

Doing business as

South Salem Apothecary

Practice address

990 Commercial St SE
Salem, OR 97302-4110

Phone

(503) 967-2405

Fax

(503) 217-7940

NPI assigned

Nov 27, 2012

Last updated

Mar 19, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana Courtney

Title

Owner

Phone

(503) 967-2405

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• South Salem Apothecary Doing business as

Tax ID family

Lake Shore Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• South Salem Apothecary, LLC

  dba South Salem Apothecary

  • Community/Retail Pharmacy
  • Salem, OR
  • NPI 1952358780
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1063756393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024110",
            "telephone_number": "503-967-2405",
            "fax_number": "503-217-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024110",
            "telephone_number": "503-967-2405",
            "fax_number": "503-217-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SALEM APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-27",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "COURTNEY",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-967-2405"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP0002754CS",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3844532",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Salem Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• South Salem Apothecary, LLC (South Salem Apothecary)
• South Salem Immediate Care Inc. (DBA Urgent Care Clinic South)
• South Salem Orthodontics LLC
• South Salem Rehabilitation, Inc.
• South Salem Rehabilitation, LLC (Salem Transitional Care)

• Community/Retail Pharmacy in Salem, OR
• Providers in Salem, OR by specialty
• Community/Retail Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.