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Organization
VIC'S FAMILY PHARMACY INC
Active
Organization
VIC'S FAMILY PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS L WALTHALL RPH (PHARMACIST IN CHARGE)
(208) 922-4400
Entity
Organization
Contact information
Practice address
173 E 4TH ST, KUNA, ID 83634-2103
(208) 922-4400
(208) 922-4499
Mailing address
119 S VALLEY DR STE A, NAMPA, ID 83686-2985
(208) 922-4400
(208) 922-4499
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
1271CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1271CP
BOARD OF PHARMACY
ID
01
—
1306251
NATL ASSO BOARD OF PHARMA
ID
05
—
8044295400
—
ID
Enumeration date
10/10/2005
Last updated
10/29/2009
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