| NPI | 1285680546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ELIOPULOS Enrollment Assistant Manager 208-395-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NH 0654P) |
| Additional Taxonomies | 333600000X Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-06-27 |