| NPI | 1750442315 |
|---|---|
| Other Name | STATE HOSPITAL SOUTH PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TRACEY G. SESSIONS Administrative Director 208-785-8406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: ID 462HP) |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: ID 462HP) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-06-16 |