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Organization
TRINITY VALLEY PHARMACY, LLC
Active
Organization
TRINITY VALLEY PHARMACY, LLC
Active
Other names
TRINITY VALLEY PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CLARISSA ELAINE FREE CPHT (OWNER)
(541) 474-9437
Entity
Organization
Contact information
Practice address
2001 NE FOOTHILL BLVD STE F3, GRANTS PASS, OR 97526-7901
(541) 474-9437
(541) 955-4575
Mailing address
2001 NE FOOTHILL BLVD STE F3, GRANTS PASS, OR 97526-7901
(541) 474-9437
(541) 955-4575
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
001859
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079118
PK
—
05
—
226575
—
OR
Enumeration date
08/10/2006
Last updated
01/26/2021
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