| NPI | 1023004348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORI DANIEL SHAVER Owner 208-232-9392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: ID 1319LS) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: ID 1319LS) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2009-08-10 |