| NPI | 1851854095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS C. HURST Pharmacy Supervisor 208-745-9201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 3336C0002X Pharmacy, Clinic Pharmacy | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2024-11-19 |