Organization
STATE OF IDAHO-DBA IDAHO STATE SCHOOL & HOSPITAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BROETJE (ADMINISTRATIVE DIRECTOR)
(208) 442-2812
Entity
Organization
Contact information
Practice address
1660 11TH AVE N, NAMPA, ID 83687-5000
(208) 442-2812
(208) 467-3406
Mailing address
1660 11TH AVE N, NAMPA, ID 83687-5000
(208) 442-2812
(208) 467-3406
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
539-HP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0028335600
—
ID
Enumeration date
03/23/2007
Last updated
08/22/2020
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