NPI age
19 years
Enumerated 2006-08-11
Across 397 active pharmacy providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1770594806 | |
| 01 | 2021058 | PK |
Doing-business-as, former, and alternate names recorded by NPPES.
Multi-provider organization. 1 individual provider on file at this primary address.
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