Organization
PENNY WISE DRUG STORES INC
Active
Other names
PENNY WISE DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS WILSON (SECE TREAS)
(208) 459-2134
Entity
Organization
Contact information
Practice address
802 CLEVELAND BLVD, CALDWELL, ID 83605-4149
(208) 459-3691
(208) 459-0189
Mailing address
PO BOX 278, CALDWELL, ID 83606-0278
(208) 459-3691
(208) 459-0189
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
302RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003087600
—
ID
05
—
003088000
—
ID
01
—
2019725
PK
—
Enumeration date
12/18/2006
Last updated
09/30/2014
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