Organization
SUPER SAVE DRUG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TORI DANIEL SHAVER (VICE PRESIDENT)
(208) 232-9392
Entity
Organization
Contact information
Practice address
701 EAST CENTER, POCATELLO, ID 83205-4869
(208) 232-7750
(208) 233-3343
Mailing address
PO BOX 4869, 701 EAST CENTER, POCATELLO, ID 83205-4869
(208) 232-7750
(208) 233-3343
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
DME197
ID
Other
Enumeration date
09/22/2005
Last updated
08/22/2020
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