| NPI | 1326035585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ALLEN PORTER Pharmacist/Manager 208-263-1408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-02-16 |