Organization
PHARMACY SHOP INC
Active
Other names
Ed Snells Pharmacy Shop
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD L SNELL RPH CCN (PRESIDENT)
(208) 232-0049
Entity
Organization
Contact information
Practice address
1015 E YOUNG, POCATELLO, ID 83201
(208) 232-0049
(208) 232-3963
Mailing address
1015 E YOUNG, POCATELLO, ID 83201
(208) 232-0049
(208) 232-3963
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
801CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002631400
MEDICAID
ID
05
—
002631600
—
ID
01
—
8C451
PRIVATE INS BLUE CROSS
ID
Enumeration date
12/15/2006
Last updated
06/06/2008
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