Organization
WEPORT MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHALED ELDEMERDASH RPH (MANAGING DIRECTOR)
(816) 405-2406
Entity
Organization
Contact information
Practice address
1220 S VISTA AVE STE A, BOISE, ID 83705-2530
(816) 405-2406
Mailing address
1220 S VISTA AVE STE A, BOISE, ID 83705-2530
(816) 405-2406
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
—
—
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Enumeration date
03/04/2026
Last updated
03/30/2026
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