| NPI | 1144910878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GOTTS Credentialing Specialist 208-509-3088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-05-08 |