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Organization
SANDPOINT SUPER DRUG CLINICAL
Active
Organization
SANDPOINT SUPER DRUG CLINICAL
Active
Other names
Sandpoint Super Drug Clinical Services
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT PORTER PHARMD (AUTHORIZED OFFICIAL)
(208) 263-1408
Entity
Organization
Contact information
Practice address
604 N FIFTH AVE, SANDPOINT, ID 83864-1520
(208) 263-1408
Mailing address
604 N FIFTH AVE, SANDPOINT, ID 83864-1520
(208) 263-1408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
3336C0002X
Clinic Pharmacy
—
NULL
Other
Enumeration date
12/01/2021
Last updated
03/24/2022
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