NPI age
12 years
Enumerated 2013-12-09
Across 48 active pharmacy providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1053742577 | |
| 01 | 2157649 | PK |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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