Organization
LADD FAMILY PHARMACY LLC
Active
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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