NPI age
19 years
Enumerated 2006-08-29
Across 397 active pharmacy providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 804043100 | |
| 01 | 1304738 | OTHER ID NUMBER-COMMERCIAL NUMBER |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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