# STATE OF IDAHO-DBA IDAHO STATE SCHOOL & HOSPITAL PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265559314
- **Authorized official:** SUSAN BROETJE (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (208) 442-2812

## Contact information

- **Practice address:** 1660 11TH AVE N, NAMPA, ID 83687-5000
- **Practice address phone:** (208) 442-2812
- **Practice address fax:** (208) 467-3406
- **Mailing address:** 1660 11TH AVE N, NAMPA, ID 83687-5000
- **Mailing address phone:** (208) 442-2812
- **Mailing address fax:** (208) 467-3406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | 539-HP | ID | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0028335600 | — | ID |