Provider Demographics
NPI:1962624262
Name:UMPQUA DRUG CO. INC
Entity type:Organization
Organization Name:UMPQUA DRUG CO. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-271-2139
Mailing Address - Street 1:1941 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467
Mailing Address - Country:US
Mailing Address - Phone:541-271-2139
Mailing Address - Fax:541-271-0228
Practice Address - Street 1:1941 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467
Practice Address - Country:US
Practice Address - Phone:541-271-2139
Practice Address - Fax:541-271-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR291260Medicaid