Central Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP-0000767 Issued in OR

Legal business name

CENTRAL DRUG STORE INC

Doing business as

Black Oak Pharmacy

Practice address

2924 Siskiyou Blvd
Ste 102
Medford, OR 97504-8194

Phone

(541) 773-5356

Fax

(541) 770-2999

NPI assigned

Jan 23, 2007

Last updated

Dec 22, 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

Title

Owner

Phone

(360) 859-8659

Specialties & licenses 3

Addresses

Other names 1

• BLACK OAK PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Central Drug Store Inc

  dba Shady Cove Pharmacy

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

  O20051117000213

  Same enrollment

Locations

Practitioners 5

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.

• Timothy L Lichlyter, RPH

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Medford, OR
  • NPI 1316390008
  NPD (past)
• Lila R Moschetti, RPH

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Shady Cove, OR
  • NPI 1285760108
  NPD (past)
• Ken Olesen, R.PH.

  • Pharmacist
  • Medford, OR
  • NPI 1992252811
  NPD (past)
• Cynthia Reinhardt, RPH

  • Pharmacist
  • Medford, OR
  • NPI 1841743051
  NPD (past)
• Ginger Marie Whitt X

  • Pharmacist
  • Shady Cove, OR
  • NPI 1154790061
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766361600000",
    "number": "1780738138",
    "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",
            "address_2": "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": "2007-01-23",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "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"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0000767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BLACK OAK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina Hansel Cellura, D.O.
• Fernando Cendejas, MD
• 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 LTC)
• Central Drug Store Inc. (Black Oak Home Medical)
• Amy Renee Cervan, PHARM.D.
• Winslow Cervantes, CRM
• Rene Gail Cervi, PHYSICAL THERAPIST

• 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 Dec 22, 2025; 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.