| NPI | 1336603463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ELIOPULOS Asst Manager Enrollments 208-395-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |