| NPI | 1174226062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH HASBROUCK Business Office Manager 208-382-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-03-22 |