| NPI | 1740902675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | P. ROMAN BURK Owner 208-855-0701 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 3336C0004X Pharmacy Compounding Pharmacy |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-09-16 |