Organization
IDAHO STATE UNIVERSITY
Active
Other names
Idaho State University Student Health Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GINA DAVIS (PHARMACY MANAGER)
(208) 282-3407
Entity
Organization
Contact information
Practice address
990 SOUTH 8TH, POCATELLO, ID 83209
(208) 282-3407
Mailing address
921 S 8TH AVE STOP 8311, POCATELLO, ID 83209-0002
(208) 282-3407
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
349CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1307974
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/27/2008
Last updated
02/03/2012
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