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Organization
IDAHO STATE VETERAN HOME - LEWISTON
Active
Organization
IDAHO STATE VETERAN HOME - LEWISTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. K DOUGLAS CRAFTON RPH (DIRECTOR OF PHARMACY)
(208) 799-3422
Entity
Organization
Contact information
Practice address
821 21ST AVE, LEWISTON, ID 83501-6389
(208) 799-3422
(208) 743-8833
Mailing address
821 21ST AVE, LEWISTON, ID 83501-6389
(208) 799-3422
(208) 743-8833
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
1042HP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307102
NCPDP NUMBER
ID
Enumeration date
08/14/2006
Last updated
03/07/2023
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