| NPI | 1164804795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON CARDONA Pharmacy Manager 208-240-1741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: ID 39073RP) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2023-03-07 |