Healthcare Provider Details

I. General information

NPI: 1679037402
Provider Name (Legal Business Name): ARNZEN SUPER DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 MICHIGAN AVE
OROFINO ID
83544-9005
US

IV. Provider business mailing address

PO BOX 429
OROFINO ID
83544-0429
US

V. Phone/Fax

Practice location:
  • Phone: 208-983-7410
  • Fax: 802-935-2477
Mailing address:
  • Phone: 208-476-3600
  • Fax: 208-476-3616

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 Number
License Number State

VIII. Authorized Official

Name: ROD F. ARNZEN
Title or Position: MANAGER
Credential: RPH
Phone: 208-476-3600