| NPI | 1104293125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMOND HAWKINS Third Party Manager 208-395-3905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2018-01-18 |