| NPI | 1710056445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA FERGUSON Executive Assistant 208-497-3575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: ID 1679LS) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-11-13 |