| NPI | 1295336709 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BLACKWOOD Credentialing Specialist 208-737-6718 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2021-06-10 |