Clearwater Canyon Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

CLEARWATER CANYON PHARMACY, LLC

Doing business as

Clearwater Canyon Pharmacy

Practice address

13020 US-12
Orofino, ID 83544

Phone

(208) 476-0110

Fax

(208) 476-0115

NPI assigned

Jan 31, 2019

Last updated

Apr 10, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Andrew Pottenger, PHARMDNPI 1386050359

Title

Owner/President

Phone

(208) 476-0110

Specialties & licenses 1

Addresses

Other names 1

• Clearwater Canyon Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Pottenger, PHARMD

  • Pharmacist
  • Lewiston, ID
  • NPI 1386050359
  NPD Authorized official
• Mikayla Danielle Moser, RPH

  • Pharmacist
  • Orofino, ID
  • NPI 1649831447
  NPD (past)
• Ernest Upshaw, PHARMD

  • Pharmacist
  • Orofino, ID
  • NPI 1497233563
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554854400000",
    "number": "1598229809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 THAIN RD",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835015530",
            "telephone_number": "208-743-5515",
            "fax_number": "208-743-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13020 US-12",
            "city": "OROFINO",
            "state": "ID",
            "postal_code": "83544",
            "telephone_number": "208-476-0110",
            "fax_number": "208-476-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER CANYON PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-04-10",
        "status": "A",
        "authorized_official_last_name": "POTTENGER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "208-476-0110",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearwater Canyon Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clearwater Canyon Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Burton, OTR/L
• Annie Cahill, LMSW
• William Edward Caldwell III
• Campfire Counseling LLC
• Mary E Clark, CPHT
• Clearwater County (Clearwater County Ambulance)
• Clearwater County Dba Back Country Medics (Back Country Medics)
• Clearwater Healthcare LLC (Clearwater Health and Rehabilitation)
• Clearwater of Cascadia
• Clearwater Valley Hospital & Clinics Inc. (Clearwater Valley Health)

• Community/Retail Pharmacy in Orofino, ID
• Providers in Orofino, ID by specialty
• Community/Retail Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.