Active NPI
Hells Canyon Health and Wellness Pharmacy
- Long Term Care Pharmacy
- Lewiston, ID
National Provider Identifier
1619507761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- HELLS CANYON HEALTH AND WELLNESS PHARMACY
- Practice address
- 523 Thain Rd
Lewiston, ID 83501-5530 - Phone
- (208) 743-5515
- NPI assigned
- Jan 16, 2020
- Organization subpart
- Yes
- Parent organization
- HELLS CANYON HEALTH AND WELLNESS PHARMACY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles Andrew Pottenger
- Title
- Owner
- Phone
- (208) 743-5515
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Primary |
Addresses
Primary practice location
523 Thain Rd
Lewiston, ID 83501-5530
Mailing address
523 Thain Rd
Lewiston, ID 83501-5530
Other names 1
- Hells Canyon Pharmacy LTC
National Provider Directory
National Provider Directory- Part of
- Hells Canyon Health and Wellness Pharmacy
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Community/Retail Pharmacy
- Lewiston, ID
- NPI 1457739989
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Lewiston, ID
- NPI 1386050359
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579132800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1579132800000",
"number": "1619507761",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 THAIN RD",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835015530",
"telephone_number": "208-743-5515"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HELLS CANYON HEALTH AND WELLNESS PHARMACY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "HELLS CANYON HEALTH AND WELLNESS PHARMACY",
"enumeration_date": "2020-01-16",
"last_updated": "2020-01-16",
"certification_date": "2020-01-16",
"status": "A",
"authorized_official_last_name": "POTTENGER",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "ANDREW",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-743-5515"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Hells Canyon Pharmacy LTC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.