South Salem Apothecary, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SOUTH SALEM APOTHECARY, LLC

Doing business as

South Salem Apothecary

Practice address

990 Commercial St SE
Salem, OR 97302-4110

Phone

(503) 967-2407

Fax

(503) 217-7940

NPI assigned

May 27, 2006

Last updated

Dec 18, 2012By 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

Diana Courtney, R PHNPI 1922131739

Title

Owner

Phone

(503) 967-2407

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• South Salem Apothecary Doing business as

Tax ID family

Lake Shore Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• South Salem Apothecary LLC

  dba South Salem Apothecary

  • Community/Retail Pharmacy
  • Salem, OR
  • NPI 1063756393
  NPD tax ID

Locations

Practitioners 1

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.

• Diana Courtney, RPH

  • Pharmacist
  • Lake Oswego, OR
  • NPI 1922131739
  NPD (past) Authorized official

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1952358780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024110",
            "telephone_number": "503-967-2407",
            "fax_number": "503-217-7940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024110",
            "telephone_number": "503-967-2407",
            "fax_number": "503-217-7940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SALEM APOTHECARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2012-12-18",
        "status": "A",
        "authorized_official_last_name": "COURTNEY",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-967-2407",
        "authorized_official_credential": "R PH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OR",
            "license": "RP0002199CS",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231440",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3841865",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Salem Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Salem, OR
• Providers in Salem, 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 18, 2012; 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.