| NPI | 1982640769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY GIANNAKOPOULOS Enrollments Manager 208-395-3954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: TX 21994) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2024-06-12 |