| NPI | 1326702010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY GIANNAKOPOULOS Enrollments Manager 208-395-3954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2021-10-28 |