Organization
TRINITY VALLEY PHARMACY LLC
Active
Other names
TRINITY VALLEY PHARMACY LLC RETAIL
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, BLDG F3, GRANTS PASS, OR 97526-3947
(541) 474-9437
(541) 955-4575
Mailing address
2001 NE FOOTHILL BLVD, BLDG F3, GRANTS PASS, OR 97526-3947
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0001885
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079136
PK
—
05
—
226575
—
OR
Enumeration date
03/26/2007
Last updated
01/26/2021
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