Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Sandpoint Super Drug Clinical

Organization Family Medicine Physician · NPI 1104584739

Sandpoint Super Drug Clinical is a Family Medicine Physician in Sandpoint, Idaho. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2

Practice location Address checks out

604 N Fifth Ave
Sandpoint, ID 83864-1520
Phone: (208) 263-1408
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Clinic Pharmacy Taxonomy 3336C0002X

Record details

NPI number1104584739
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Scott Porter — Authorized Official · (208) 263-1408
Other names Sandpoint Super Drug Clinical Services; Sandpoint Super Drug Clinical Services
NPI enumeratedDecember 1, 2021
Last updated in NPPESMarch 24, 2022
Certification dateMarch 24, 2022
Mailing address604 N Fifth Ave, Sandpoint, ID 83864-1520

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