| NPI | 1366275638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS C HURST Pharmacy Director 208-745-9201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-08-22 |
| Last Update Date | 2025-02-19 |