Organization
FOGG DRUG CO INC
Active
Other names
HYWAY DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN FOGG RPH (MANAGER)
(208) 522-8357
Entity
Organization
Contact information
Practice address
120 NORTHGATE MILE, IDAHO FALLS, ID 83401-2543
(208) 522-8357
(208) 528-0288
Mailing address
120 NORTHGATE MILE, IDAHO FALLS, ID 83401-2543
(208) 522-8357
(208) 528-0288
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
214RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002291200
—
ID
01
—
2020088
PK
—
Enumeration date
01/30/2007
Last updated
12/22/2014
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