Organization
ADAMS COUNTY HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN DOMECQ (CHIEF FINANCIAL OFFICER)
(208) 253-4242
Entity
Organization
Contact information
Practice address
205 N BERKLEY ST, COUNCIL, ID 83612-5015
(208) 253-4957
(208) 253-4958
Mailing address
PO BOX 428, COUNCIL, ID 83612-0428
(208) 253-4957
(208) 253-4958
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
43512LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166314
PK
—
Enumeration date
11/07/2016
Last updated
03/13/2017
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