Provider Demographics
NPI:1679037402
Name:ARNZEN SUPER DRUG, INC
Entity Type:Organization
Organization Name:ARNZEN SUPER DRUG, INC
Other - Org Name:ARNZEN'S GLENWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:F
Authorized Official - Last Name:ARNZEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-476-3600
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-0429
Mailing Address - Country:US
Mailing Address - Phone:208-476-3600
Mailing Address - Fax:208-476-3616
Practice Address - Street 1:1105 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9005
Practice Address - Country:US
Practice Address - Phone:208-983-7410
Practice Address - Fax:802-935-2477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARNZEN SUPER DRUG, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-25
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy