| NPI | 1447814033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY JOHNSON LLC Member In Process 208-220-8599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-04-29 |