NPI age
15 years
Enumerated 2011-04-06
Across 1739 active pharmacist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | CS12296 | IDAHO CONTROLLED SUBSTANCE REGISTRATION |
| 01 (ID) | P6104 | IDAHO PHARMACIST LICENSE |
Part of a multi-provider practice. 5 other active providers share this practice address in NPPES.
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