Organization
CLEARWATER CANYON PHARMACY, LLC
Active
Other names
Clearwater Canyon Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ANDREW POTTENGER PHARMD (OWNER/PRESIDENT)
(208) 476-0110
Entity
Organization
Contact information
Practice address
13020 US-12, OROFINO, ID 83544
(208) 476-0110
(208) 476-0115
Mailing address
523 THAIN RD, LEWISTON, ID 83501-5530
(208) 743-5515
(208) 743-0333
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
01/31/2019
Last updated
04/10/2019
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