Organization
TETON CLINICAL PHARMACY INC
Active
Other names
TETON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BAILEY PHARMD (OWNER)
(208) 529-3636
Entity
Organization
Contact information
Practice address
2470 JAFER CT, IDAHO FALLS, ID 83404-5587
(208) 529-3636
(208) 528-6562
Mailing address
2470 JAFER CT, IDAHO FALLS, ID 83404-5587
(208) 529-3636
(208) 528-6562
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2226RP
ID
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002551700
—
ID
05
—
1043629397
—
ID
01
—
2020627
PK
—
Enumeration date
08/12/2005
Last updated
07/13/2016
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