Eden Healthcare LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

EDEN HEALTHCARE LLC

Practice address

843 E Main St Ste 204
Medford, OR 97504-7137

Phone

(541) 329-0478

Fax

(541) 314-9556

NPI assigned

Feb 3, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Dane Fickes, PHARMDNPI 1225514375

Title

Owner

Phone

(541) 329-0478

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Dane M Fickes, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Medford, OR
  • NPI 1225514375
  NPD Authorized official

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627171200000",
    "number": "1194317909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "843 E MAIN ST STE 204",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047137",
            "telephone_number": "541-329-0478",
            "fax_number": "541-314-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 E MAIN ST STE 204",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047137",
            "telephone_number": "541-329-0478",
            "fax_number": "541-314-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-07-25",
        "certification_date": "2021-07-25",
        "status": "A",
        "authorized_official_last_name": "FICKES",
        "authorized_official_first_name": "DANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-329-0478",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF PHARMACY RETAIL DRUG OUTLET LICENSE",
            "identifier": "RP-0003659",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Lacey Echalier, M.D.
• Lizabeth M. Eckerd, PH.D.
• Robert Walter Eckert, MD
• Eclectic Behavioral Health Solutions LLC (Restoring Essential Connections)
• Jessica Eddington
• Eden Practitioners LLC (Eden Practitioners)
• Brandon Edgar
• Brianna Edmond
• Emmanuel Edson, MD
• Edward a. Helman

• Community/Retail Pharmacy in Medford, OR
• Providers in Medford, 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 Jul 25, 2021; 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.