# HELLS CANYON HEALTH AND WELLNESS PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HELLS CANYON HEALTH AND WELLNESS PHARMACY
- **Other names:** Hells Canyon Pharmacy LTC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619507761
- **Legal business name:** HELLS CANYON HEALTH AND WELLNESS PHARMACY
- **Authorized official:** CHARLES ANDREW POTTENGER (OWNER)
- **Authorized official phone:** (208) 743-5515

## Contact information

- **Practice address:** 523 THAIN RD, LEWISTON, ID 83501-5530
- **Practice address phone:** (208) 743-5515
- **Mailing address:** 523 THAIN RD, LEWISTON, ID 83501-5530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/16/2020
- **Last updated:** 01/16/2020