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
—
—
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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