| NPI | 1154636371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ELIOPULOS Assistant Manager, Enrollments 208-395-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: VA 0201004355) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2018-09-27 |