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Organization
T2 APOTHECARY
Active
Organization
T2 APOTHECARY
Active
Other names
KJ's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GILL WADSWORTH PHARM.D. (OWNER)
(208) 733-9242
Entity
Organization
Contact information
Practice address
615 FILER AVE, TWIN FALLS, ID 83301-4008
(208) 733-9242
(208) 733-2810
Mailing address
615 FILER AVE, TWIN FALLS, ID 83301-4008
(208) 733-9242
(208) 733-2810
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
37753RP
ID
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002654200
—
ID
01
—
2020843
PK
—
Enumeration date
12/26/2006
Last updated
03/24/2016
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