| NPI | 1851923544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY COULSON Pharmacist In Charge 208-528-9658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2021-08-09 |