Organization
DEBLAQUIERE ENTERPRISES, INC.
Active
Other names
White Cross Pharmacy - Oldtown
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD ALLAN DE BLAQUIERE PHARMD (PRESIDENT)
(208) 610-0752
Entity
Organization
Contact information
Practice address
86 TANK RD, OLDTOWN, ID 83822-5126
(208) 457-7160
(208) 369-4553
Mailing address
PO BOX 3525, OLDTOWN, ID 83822-3525
(208) 457-7160
(208) 369-4553
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841806494
—
ID
Enumeration date
09/18/2020
Last updated
12/03/2021
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