Organization · Type 2 NPI

Clearwater Canyon Pharmacy, LLC

Community/Retail Pharmacy · Orofino, ID

NPI number 1598229809 Active

Practice location

13020 US-12
Orofino, ID 83544

Call (208) 476-0110 Map

Fax (208) 476-0115

Mailing address

523 Thain Rd
Lewiston, ID 83501-5530

Specialties and licenses

Taxonomy	Code	License
Community/Retail Pharmacy Primary	3336C0003X	None listed

Community/Retail Pharmacy: A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other …

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NPI record

NPI: 1598229809
Entity type: Organization (Type 2)
Issued: Jan 31, 2019
Last updated: Apr 10, 2019
Status: Active

Other names

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Clearwater Canyon Pharmacy · doing business as
Clearwater Canyon Pharmacy · doing business as

Authorized official

Charles Andrew Pottenger, PharmD
Owner/president
(208) 476-0110

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1598229809

Clearwater Canyon Pharmacy, LLC's National Provider Identifier is 1598229809, issued on Jan 31, 2019. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Orofino, ID. The record was last updated on Apr 10, 2019.