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Organization
IDAHO STATE UNIVERSITY
Active
Organization
IDAHO STATE UNIVERSITY
Active
Other names
Idaho State University Student Health Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GINA DAVIS (PHARMACY MANAGER)
(208) 282-3407
Entity
Organization
Contact information
Practice address
990 SOUTH 8TH, POCATELLO, ID 83209
(208) 282-3407
Mailing address
921 S 8TH AVE STOP 8311, POCATELLO, ID 83209-0002
(208) 282-3407
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
349CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307974
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/27/2008
Last updated
02/03/2012
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