| NPI | 1497751234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SETH W HASLAM Pharmacist Owner 208-852-1563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P3954) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2023-03-07 |