Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Bengal Pharmacy Chubbuck
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
4914 YELLOWSTONE AVE STE A, CHUBBUCK, ID 83202-2332
(208) 282-5790
(208) 237-3906
Mailing address
990 S 8TH AVE STOP 8158, POCATELLO, ID 83201-4982
(208) 282-3407
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
06/14/2023
Last updated
05/15/2024
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