NPI 1598229809

Clearwater Canyon Pharmacy, LLC

Organisation Community/Retail Pharmacy Orofino, ID

Practice location

Address: 13020 Us-12, Orofino, ID 83544
Phone: (208) 476-0110
Fax: (208) 476-0115
Mailing address: 523 Thain Rd, Lewiston, ID 83501-5530

Authorised official

Name: Charles Andrew Pottenger
Title: Owner/President
Phone: (208) 476-0110

Registered specialties

Community/Retail Pharmacy Primary

Suppliers Taxonomy 3336C0003X

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Registry record

NPI: 1598229809
Entity type: Organization
NPI issued: 31 Jan 2019
Record last updated: 10 Apr 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.