Organization
JERSHAN ENTERPRISES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERAMY RANDALL NEIBAUR PHARM.D. (PRESIDENT)
(208) 356-4481
Entity
Organization
Contact information
Practice address
167 W MAIN ST STE 1, REXBURG, ID 83440-1826
(208) 356-4481
Mailing address
167 W MAIN ST STE 1, REXBURG, ID 83440-1826
(208) 356-4481
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
03/11/2026
Last updated
05/03/2026
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