Organization
LADD FAMILY PHARMACY LLC
Active
Parent organization
LADD FAMILY PHARMACY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LADD FAMILY PHARMACY LLC
Authorized official
JEREMY LUNDEVALL (C.O.O)
(208) 947-0877
Entity
Organization
Contact information
Practice address
2000 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3138
(208) 947-0877
(208) 947-0874
Mailing address
1109 S BROADWAY AVE, BOISE, ID 83706-3626
(208) 947-0877
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
46393LS
ID
Other
Enumeration date
09/29/2017
Last updated
09/29/2017
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