| NPI | 1821036781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY GIANNAKOPOULOS Enrollment Manager 208-395-3954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: TX 10858) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-06-17 |