NPI age
20 years
Enumerated 2005-08-10
Across 117 active pharmacy providers in Idaho.
20 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1145CP | PHARMACY LICENSE |
| 01 | 1306011 | NABP |
| 01 (ID) | 20022777 | MEDICARE - PART B VACCINES |
| 05 (ID) | 002253500 |
Doing-business-as, former, and alternate names recorded by NPPES.
Multi-provider organization. 20 individual providers on file at this primary address.
Subpart of St Lukes Health System Ltd.
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