Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Bengal Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
990 S CESAR CHAVEZ, POCATELLO, ID 83209-0001
(208) 282-3407
(208) 282-6150
Mailing address
921 S 8TH AVE STOP 8158, POCATELLO, ID 83209-0002
(208) 282-3407
(208) 282-6150
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/16/2020
Last updated
12/22/2020
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