Central Drug Store Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

RP0000767 Issued in OR

Legal business name

CENTRAL DRUG STORE INC.

Doing business as

Black Oak Home Medical

Practice address

4800 Crater Lake Ave
Medford, OR 97504-9753

Phone

(541) 773-5083

NPI assigned

Oct 21, 2008

Last updated

Dec 29, 2025By 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

Jeffrey Harrell, PHARMD

Title

Owner

Phone

(360) 859-8659

Specialties & licenses 1

Addresses

Other names 1

• Black Oak Home Medical Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Central Drug Store Inc

  dba Shady Cove Pharmacy

  • Community/Retail Pharmacy
  • Shady Cove, OR
  • NPI 1790830446

  6608895735

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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.

• Central Drug Store Inc

  dba Shady Cove Pharmacy

  • Community/Retail Pharmacy
  • Shady Cove, OR
  • NPI 1790830446
  NPD tax ID
• Central Drug Store Inc.

  dba Black Oak Pharmacy LTC

  • Long Term Care Pharmacy
  • Medford, OR
  • NPI 1124847074
  NPD tax ID

Locations

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1629220678",
    "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": "4800 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975049753",
            "telephone_number": "541-773-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL DRUG STORE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-859-8659",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OR",
            "license": "RP0000767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Oak Home Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joel Andres Centeno, DPT
• Center for Regenerative Orthopedic Medicine, PC
• Center of Orthopedic Rehabilitation & Exercise, LLC (CORE Physical Therapy & Training)
• Central Drug Store Inc (Black Oak Pharmacy)
• Central Drug Store Inc. (Black Oak Pharmacy LTC)
• Amy Renee Cervan, PHARM.D.
• Winslow Cervantes, CRM
• Rene Gail Cervi, PHYSICAL THERAPIST
• Patrick Chabra
• Heather Chalmers Faith, CPM, LDM

• Durable Medical Equipment & Medical Supplies in Medford, OR
• Providers in Medford, OR by specialty
• Durable Medical Equipment & Medical Supplies in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.