| NPI | 1225668957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARA HAYES Sole Member / Pharmacist In Charge 208-287-4667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2020-03-03 |