NPIMap

Organization Active NPI

Siskiyou Community Health Center Pharmacy

  • Community/Retail Pharmacy
  • Grants Pass, OR
National Provider Identifier
1881049658
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
RP-0002572-CS Issued in OR
Legal business name
SISKIYOU COMMUNITY HEALTH CENTER PHARMACY
Practice address
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone
(541) 472-4777
Fax
(541) 471-3665
NPI assigned
Apr 29, 2016
Organization subpart
Yes
Parent organization
SISKIYOU COMMUNITY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

Name
Eric Van Houten, MSW, MBA
Title
Ceo
Phone
(541) 472-4777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X RP-0002572-CS OR Primary

Addresses

Primary practice location

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051

Mailing address

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 472-4777

Other identifiers 1

IdentifierTypeStateIssuer
500711967MedicaidOR

National Provider Directory

National Provider Directory
Tax ID family
Siskiyou Community HLTH13 organizations share this tax ID, including this one
Part of
Siskiyou Community HLTH

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1881049658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-472-4777",
            "fax_number": "541-471-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-472-4777",
            "fax_number": "541-471-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISKIYOU COMMUNITY HEALTH CENTER PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SISKIYOU COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2016-04-29",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "VAN HOUTEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-472-4777",
        "authorized_official_credential": "MSW, MBA"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP-0002572-CS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500711967",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; 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.