Organization
IDAHO RX INC
Active
Other names
Idaho Drug
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE PERMANN (CO-OWNER)
(208) 745-6831
Entity
Organization
Contact information
Practice address
139 E MAIN ST, RIGBY, ID 83442-1417
(208) 745-6831
(208) 745-6161
Mailing address
139 E MAIN ST, RIGBY, ID 83442-1417
(208) 745-6831
(208) 745-6161
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2171RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124041
PK
—
05
—
807007100
—
ID
Enumeration date
02/23/2007
Last updated
04/26/2016
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