# TRINITY VALLEY PHARMACY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TRINITY VALLEY PHARMACY LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639180201
- **Authorized official:** CLARISSA ELAINE FREE CPHT (OWNER)
- **Authorized official phone:** (541) 474-9437

## Contact information

- **Practice address:** 2001 NE FOOTHILL BLVD STE F3, GRANTS PASS, OR 97526-7901
- **Practice address phone:** (541) 474-9437
- **Practice address fax:** (541) 955-4575
- **Mailing address:** 2001 NE FOOTHILL BLVD STE F3, GRANTS PASS, OR 97526-7901
- **Mailing address phone:** (541) 474-9437
- **Mailing address fax:** (541) 955-4575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 001859 | OR | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 01/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2079118 | PK | — |
| 05 | — | 226575 | — | OR |