Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Pharmacist Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
4914 YELLOWSTONE AVE STE B, CHUBBUCK, ID 83202-2332
(208) 282-2005
Mailing address
990 S 8TH AVE STOP 8158, POCATELLO, ID 83201-4982
(800) 627-4781
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
11/15/2022
Last updated
06/14/2023
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