| NPI | 1114629961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH HASBROUCK Business Practice Manager 208-382-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2023-03-17 |