NPIMap

Organization Active NPI

Central Drug Store Inc.

  • Long Term Care Pharmacy
  • Medford, OR
National Provider Identifier
1124847074
Registry record updated Dec 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
CENTRAL DRUG STORE INC.
Practice address
2924 Siskiyou Blvd Ste 102
Medford, OR 97504-8194
Phone
(541) 773-5356
Fax
(541) 770-2999
NPI assigned
Oct 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2025

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

Authorized official

Name
Jeffrey Shane Harrell, PHARMD
Title
Owner
Phone
(360) 859-8659

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

2924 Siskiyou Blvd Ste 102
Medford, OR 97504-8194

Mailing address

PO Box B
Ilwaco, WA 98624-0167

Other names 1

  • Black Oak Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Black Oak Home Medical3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2924 Siskiyou Blvd
Ste 102
Medford, OR 97504
Phone (541) 773-5356

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766188800000",
    "number": "1124847074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX B",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2924 SISKIYOU BLVD STE 102",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048194",
            "telephone_number": "541-773-5356",
            "fax_number": "541-770-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL DRUG STORE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-08",
        "last_updated": "2025-12-20",
        "certification_date": "2025-12-20",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-859-8659",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Oak Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2025; 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.