# BYU ID STUDENT HLTH CNTR PCHY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BYU-IDAHO STUDENT HEALTH CENTER PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992726962
- **Authorized official:** SHAWN ANDREASEN PHARMD RPH (PCHY DIR)
- **Authorized official phone:** (208) 496-9330

## Contact information

- **Practice address:** 179 STUDENT HLTH CTR, REXBURG, ID 83460-0001
- **Practice address phone:** (208) 496-9330
- **Practice address fax:** (208) 496-9343
- **Mailing address:** 179 STUDENT HLTH CTR, REXBURG, ID 83460-0001
- **Mailing address phone:** (208) 496-9330
- **Mailing address fax:** (208) 496-9343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | 614RP | ID | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 04/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2020561 | PK | — |