| NPI | 1457880940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY ELIOPULOS Asst Mgr, Pharmacy Enrollments 208-395-3906 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2018-08-10 |