Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Bengal Pharmacy Pocatello
Organization subpart
No
Provider details
NPI number
Authorized official
RIKKI K TRUSSEL (PHARMACY MANAGER)
(208) 282-3407
Entity
Organization
Contact information
Practice address
990 S 8TH AVE, POCATELLO, ID 83201-4982
(208) 282-3407
(208) 282-6150
Mailing address
990 S 8TH AVE, STOP 8158, POCATELLO, ID 83209-0001
(208) 282-3407
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497194013
—
ID
Enumeration date
06/17/2013
Last updated
04/04/2022
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