| NPI | 1316771595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA SUE WADSWORTH Credentialing 208-523-3360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-08-29 |