Achterhof Healthcare Pharmacy, LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

001218 Issued in OR

Legal business name

ACHTERHOF HEALTHCARE PHARMACY, LLC

Doing business as

Managed Healthcare Pharmacy

Practice address

1750 Willow Creek Cir
Eugene, OR 97402-9152

Phone

(541) 744-1641

NPI assigned

Sep 9, 2005

Last updated

Jan 27, 2016By 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

Randall Scott Klemm, RPHNPI 1912221441

Title

Operations Manager

Phone

(541) 744-1641

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Managed Healthcare Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Achterhof Healthcare Pharmacy, LLC

  dba MHP Medford

  • Institutional Pharmacy
  • Medford, OR
  • NPI 1003685819
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randall Klemm, RPH

  • Pharmacist
  • Eugene, OR
  • NPI 1912221441
  NPD (past) Authorized official
• Nicholas Ryan Dibos

  • Pharmacist
  • Eugene, OR
  • NPI 1023507613
  NPD (past)

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1225022841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2767",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020308",
            "telephone_number": "541-744-1641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 WILLOW CREEK CIR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974029152",
            "telephone_number": "541-744-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACHTERHOF HEALTHCARE PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "KLEMM",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "541-744-1641",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OR",
            "license": "001218",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OR",
            "license": "001218",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OR",
            "license": "IP-0001218-CS",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181401",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181400",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Managed Healthcare Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Eugene, OR
• Providers in Eugene, OR by specialty
• Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.