| NPI | 1861780330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR ALLEN Owner 208-465-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: ID 16667RP) |
| Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2019-02-13 |