ACHTERHOF HEALTHCARE PHARMACY, LLC (MANAGED HEALTHCARE PHARMACY) - NPI NUMBER 1225022841

Summary

Provider Name: ACHTERHOF HEALTHCARE PHARMACY, LLC (MANAGED HEALTHCARE PHARMACY)

NPI Number: 1225022841

Clasification: Durable Medical Equipment & Medical Supplies (332B00000X)

Address:
1750 WILLOW CREEK CIR
EUGENE, OR
ZIP 97402

Phone Number: (541) 744-1641



Detailed Information

ACHTERHOF HEALTHCARE PHARMACY, LLC is a durable medical equipment & medical supplies in Eugene, OR. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient�s use in the home and that are usable for an extended period of time. The assigned NPI number for this provider is 1225022841 and is registered as an organization entity type.
The provider Is Doing Business As Managed Healthcare Pharmacy.

The provider's business address is:

1750 WILLOW CREEK CIR
EUGENE, OR
ZIP 97402-152
Phone: (541) 744-1641

The provider's authorized official is Randall Scott Klemm .
The authorized official title is Operations Manager and has the following contact phone number (541) 744-1641.

The enumeration date for this NPI number is 9/9/2005 and was last updated on 7/26/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 332B00000X Durable Medical Equipment & Medical Supplies 001218 OR No
2 333600000X Pharmacy 001218 OR Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 181400 MEDICAID OR
2 R130865 MEDICARE PIN OR
3 181401 MEDICAID OR
4 4563140001 MEDICARE NSC OR

NPI Record

No. Field Name Field Value
1 NPI 1225022841
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name ACHTERHOF HEALTHCARE PHARMACY, LLC
5 Provider Other Organization Name MANAGED HEALTHCARE PHARMACY
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 1750 WILLOW CREEK CIR
8 Provider Business Practice Location Address City Name EUGENE
9 Provider Business Practice Location Address State Name OR
10 Provider Business Practice Location Address Postal Code 974029152
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 5417441641
13 Provider Enumeration Date 9/9/2005
14 Last Update Date 7/26/2013
15 Authorized Official Last Name KLEMM
16 Authorized Official First Name RANDALL
17 Authorized Official Middle Name SCOTT
18 Authorized Official Title or Position OPERATIONS MANAGER
19 Authorized Official Telephone Number 5417441641
20 Healthcare Provider Taxonomy Code 1 332B00000X
21 Provider License Number 1 001218
22 Provider License Number State Code 1 OR
23 Healthcare Provider Primary Taxonomy Switch 1 N
24 Healthcare Provider Taxonomy Code 2 333600000X
25 Provider License Number 2 001218
26 Provider License Number State Code 2 OR
27 Healthcare Provider Primary Taxonomy Switch 2 Y
28 Other Provider Identifier 1 181400
29 Other Provider Identifier Type Code 1 05
30 Other Provider Identifier State 1 OR
31 Other Provider Identifier 2 R130865
32 Other Provider Identifier Type Code 2 08
33 Other Provider Identifier State 2 OR
34 Other Provider Identifier 3 181401
35 Other Provider Identifier Type Code 3 05
36 Other Provider Identifier State 3 OR
37 Other Provider Identifier 4 4563140001
38 Other Provider Identifier Type Code 4 07
39 Other Provider Identifier State 4 OR
40 Is Organization Subpart N
41 Authorized Official Credential Text RPH

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.