| NPI | 1740717693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN LUNT Pharmacist 208-240-3733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: ID 44698RP) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2022-07-21 |