NPI age
7 years
Enumerated 2019-01-31
● Active Type 2 · Organization
Clearwater Canyon Pharmacy, Llc
Clearwater Canyon Pharmacy, Llc is 1 of 397 pharmacy organizations in Idaho.
Primary specialty
Pharmacy
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Pottenger
Owner/president
Last NPPES update
2019-04-10
Source: monthly bulk 2026-05
How this organization compares
Across 397 active pharmacy providers in Idaho.
NPI age
7 years
↓ 12 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2019 → 2026
2019-01Enumerated in NPPES
2019
2026
Where they practice
Primary practice location
13020 Us-12
Orofino, ID 83544
Mailing address
523 Thain Rd
Lewiston, ID 835015530
Authorized official
Charles Andrew Pottenger, PHARMD
Owner/president
📞 2084760110
Specialties
-
Pharmacy PrimaryA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the...
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Clearwater Canyon Pharmacy
-
Clearwater Canyon Pharmacy
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.