| NPI | 1366630436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RYAN BRONSELL Staff Pharmacist 208-524-4480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: ID P6096) |
| Enumeration Date | 2007-10-13 |
| Last Update Date | 2007-10-13 |