| NPI | 1881697118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NED HILLYARD Owner/Manager 208-709-4571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| 333600000X Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2021-01-12 |