Organization
ONTARIO PHARMACY INC
Active
Other names
PARK-VU PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN JACKSON PHARMD (PHARMACIST)
(208) 452-7075
Entity
Organization
Contact information
Practice address
1118 NW 16TH ST # 150, FRUITLAND, ID 83619-2271
(208) 452-7075
(208) 452-7446
Mailing address
1118 NW 16TH ST # 150, FRUITLAND, ID 83619-2271
(208) 452-7075
(208) 452-7446
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
36033RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002430360
—
ID
05
—
003355000
—
ID
01
—
2020336
PK
—
Enumeration date
10/20/2006
Last updated
08/05/2014
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