| NPI | 1306884499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN JOHNSON Manager Managed Healthcare 208-395-3436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TX 16217) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-12-06 |