| NPI | 1164267373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED LEE MOORE Director Of Pharmacy Services 208-514-2512 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2024-06-28 |