| NPI | 1922045368 |
|---|---|
| Doing Business As | MARKET STREET PHARMACY #0675 |
| Entity Type | Organization |
| Authorized Contact | KATHY GIANNAKOPOULOS Enrollments Manager 208-395-3954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 29388) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-02-18 |