Organization
OSBURN DRUG CO
Active
Other names
Rathdrum Drug
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD D. LAVIGNE R.PH. (PRESIDENT)
(208) 556-1139
Entity
Organization
Contact information
Practice address
16376 N HIGHWAY 41, RATHDRUM, ID 83858-8735
(208) 687-0731
(208) 556-1139
Mailing address
PO BOX 2170, OSBURN, ID 83849-2170
(208) 687-0731
(208) 687-0990
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
DME431
ID
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
DME431
ID
333600000X
Pharmacy
CP477
ID
3336C0003X
Community/Retail Pharmacy
CP477
ID
335E00000X
Prosthetic/Orthotic Supplier
DME431
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002450401
—
ID
Enumeration date
10/02/2006
Last updated
04/03/2013
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