Healthcare Provider Details

I. General information

NPI: 1376627596
Provider Name (Legal Business Name): ARNZEN SUPER DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAIN STREET BOX 787
KAMIAH ID
83536
US

IV. Provider business mailing address

318 MAIN STREET BOX 787
KAMIAH ID
83536-0787
US

V. Phone/Fax

Practice location:
  • Phone: 208-935-2301
  • Fax: 208-935-2477
Mailing address:
  • Phone: 208-935-2301
  • Fax: 208-935-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number315CP
License Number StateID

VIII. Authorized Official

Name: MR. ROD F ARNZEN
Title or Position: OWNER
Credential: RPH
Phone: 208-962-3401