| NPI | 1154532794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY F. SNIDER Pharmacist In Charge 208-265-1093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: ID 1402CP) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |