| NPI | 1336186006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN JOHNSON Manager Managed Healthcare 208-395-3436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: FL 6459) |
| Additional Taxonomies | 333600000X Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2010-12-03 |