Organization
RITE AID
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RYAN BRONSELL PHARMD (STAFF PHARMACIST)
(208) 524-4480
Entity
Organization
Contact information
Practice address
1745 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 524-4480
Mailing address
1745 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P6096
ID
Other
Enumeration date
10/13/2007
Last updated
10/13/2007
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