| NPI | 1316462393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENZO TORRES Pharmacy Enrollment Specialist 208-395-3963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2022-07-21 |