Organization
KEYMED INC
Active
Other names
Snake River Long Term Care Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID MILLS (PRESIDENT)
(208) 233-2444
Entity
Organization
Contact information
Practice address
3607 POLE LINE RD, POCATELLO, ID 83201-5531
(208) 233-2444
(208) 233-3439
Mailing address
3607 POLE LINE RD, POCATELLO, ID 83201-5531
(208) 233-2444
(208) 233-3439
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
1901LS
ID
3336L0003X
Long Term Care Pharmacy
Primary
44701LS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807012000
—
ID
Enumeration date
06/15/2006
Last updated
12/13/2022
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