| NPI | 1356432140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY GIANNAKOPOULOS Enrollments Manager 208-395-3954 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-04-24 |