| NPI | 1629169289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENZO TORRES Pharmacy Enrollment Specialist 208-395-3963 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-07-21 |