Organization
MARKETIME DRUG OF MOSCOW INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIK JAMES NELSON (OWNER)
(509) 868-6559
Entity
Organization
Contact information
Practice address
872 TROY RD STE 120, MOSCOW, ID 83843-5037
(208) 882-7541
Mailing address
872 TROY RD STE 120, MOSCOW, ID 83843-5037
(208) 882-7541
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0023396
—
ID
Enumeration date
01/05/2021
Last updated
04/01/2022
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