Provider Demographics
NPI:1972938447
Name:ORFFER, JOHANNES RETIEF (RPH)
Entity Type:Individual
Prefix:
First Name:JOHANNES
Middle Name:RETIEF
Last Name:ORFFER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6848 N GOVERNMENT WAY
Mailing Address - Street 2:STE 114 PMB #192
Mailing Address - City:DALTON GARDENS
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7799
Mailing Address - Country:US
Mailing Address - Phone:207-812-8141
Mailing Address - Fax:207-364-4776
Practice Address - Street 1:RITE AID #05420
Practice Address - Street 2:208 W IRONWOOD DR
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-664-3185
Practice Address - Fax:208-664-3481
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPR12594183500000X
IDP9038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist