| NPI | 1417188632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARA HAYES Owner 208-287-4667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336S0011X Pharmacy Specialty Pharmacy (Licence: ID 39835RP) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| 333600000X Pharmacy | |
| 3336L0003X Pharmacy Long Term Care Pharmacy | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2017-04-25 |