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Organization
IRWIN DRUG INC.
Active
Organization
IRWIN DRUG INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD GUY JUNGERT (PRESIDENT/OWNER)
(208) 983-1090
Entity
Organization
Contact information
Practice address
146 W MAIN ST, GRANGEVILLE, ID 83530-1932
(208) 983-1090
Mailing address
146 W MAIN ST, GRANGEVILLE, ID 83530-1932
(208) 983-1090
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
2081CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
807496700
MEDICAID DME
ID
05
—
807496800
—
ID
Enumeration date
01/22/2008
Last updated
05/07/2008
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