Organization
GLENWOOD PHARMACY INC
Active
Other names
Riverside Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA PETERSON (PRESIDENT)
(208) 476-5727
Entity
Organization
Contact information
Practice address
13040 HIGHWAY 12, OROFINO, ID 83544-9330
(208) 476-0329
(208) 476-0349
Mailing address
1105 MICHIGAN AVE, OROFINO, ID 83544-9005
(208) 476-0329
(208) 476-0349
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
19201RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135971
PK
—
Enumeration date
08/10/2006
Last updated
08/15/2013
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