| NPI | 1104857903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY GIANNAKOPOULOS Enrollments Maanger 208-395-3954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WA PHAR.CF.60517027) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-04-01 |