=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245036755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HEALTH CLINICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S PARADISE AVE
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83644-5809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-849-4070
-----------------------------------------------------
Fax | 208-510-5619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9 C/O PHARMACY DIRECTOR, MIDDLETON -RETAIL
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83653-0009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-849-4070
-----------------------------------------------------
Fax | 208-510-5619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | HOLLY HENGGELER
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 208-318-1315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------