Organization
LADD FAMILY PHARMACY LLC
Active
Other names
LADD FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY LUNDEVALL CPHT (COO)
(208) 947-0877
Entity
Organization
Contact information
Practice address
1109 S BROADWAY AVE, BOISE, ID 83706-3626
(208) 947-0877
(208) 947-0874
Mailing address
1109 S BROADWAY AVE, BOISE, ID 83706-3626
(208) 947-0877
(208) 947-0874
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
38076RP
ID
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022000
PK
—
05
—
M8081035
—
ID
05
—
M8081177
—
ID
Enumeration date
03/30/2008
Last updated
08/01/2017
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