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General NPI Number Information
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NPI Number | 1013034735
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Entity Type | Organization
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Legal Business Name | TRINITY VALLEY PHARMACY LLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 2001 NE FOOTHILL BLVD BLDG F3
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City | GRANTS PASS
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State | OR
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Zip | 97526-3947
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Country | US
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Telephone | 541-474-9437
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Fax | 541-955-4575
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Provider Business Mailing Address
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Address Line | 2001 NE FOOTHILL BLVD BLDG F3
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City | GRANTS PASS
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State | OR
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Zip | 97526-3947
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLARISSA ELAINE FREE
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Credential | CPHT
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Telephone | 541-474-9437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0001885
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License Number State | OR
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