| NPI | 1043794001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY HENGGELER Pharmacy Director 208-318-1315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2024-02-07 |