Organization
ED SNELL'S PHARMACY SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED SNELL RPH, CCN (PRESIDENT)
(208) 232-0049
Entity
Organization
Contact information
Practice address
1015 E YOUNG ST, POCATELLO, ID 83201-5282
(208) 232-0049
(208) 232-3963
Mailing address
1015 E YOUNG ST, POCATELLO, ID 83201-5282
(208) 232-0049
(208) 232-3963
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P4033
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010013849
BLUE CROSS OF IDAHO ID #
ID
05
—
002631600
—
ID
01
—
8C451
BLUE CROSS OF IDAHO ID #
ID
Enumeration date
07/14/2006
Last updated
06/05/2008
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