Organization
PHARMACY SHOP INC
Active
Other names
ED SNELLS PHARMACY SHOP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED SNELL (OWNER)
(208) 233-0049
Entity
Organization
Contact information
Practice address
1015 E YOUNG ST, POCATELLO, ID 83201-5282
(208) 233-0049
Mailing address
1015 E YOUNG ST, POCATELLO, ID 83201-5282
(208) 233-0049
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002631600
—
ID
Enumeration date
06/05/2008
Last updated
04/14/2011
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