Organization
ONTARIO PHARMACY INC
Active
Other names
Valley Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WHEATLEY (PHARMACIST/OWNER)
(208) 452-3340
Entity
Organization
Contact information
Practice address
1118 NW 16TH ST # 150B, FRUITLAND, ID 83619-2271
(208) 452-3340
(208) 452-7446
Mailing address
1118 NW 16TH ST # 150B, FRUITLAND, ID 83619-2271
(208) 452-3340
(208) 452-7446
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
21811LS
ID
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2142790
PK
—
Enumeration date
11/08/2013
Last updated
03/19/2014
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