Organization
LOST RIVERS HOSPITAL PHARMACY
Active
Parent organization
LOST RIVERS DISTRICT HOSPITAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOST RIVERS DISTRICT HOSPITAL
Authorized official
BRAD HUERTA (CEO)
(208) 527-8206
Entity
Organization
Contact information
Practice address
551 HIGHLAND DR, ARCO, ID 83213
(208) 527-8206
(208) 527-3105
Mailing address
PO BOX 145, ARCO, ID 83213-0145
(208) 527-8206
(208) 527-3105
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5347
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807065100
—
ID
Enumeration date
10/23/2006
Last updated
01/10/2014
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