Organization
THE HOSPICE STORE AND SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN KARL BOSH (OWNER/MANAGER)
(208) 251-1032
Entity
Organization
Contact information
Practice address
134 N 3966 E, ADDRESS 2, RIGBY, ID 83442-5772
(208) 251-1032
(208) 745-8739
Mailing address
134 N 3966 E, ADDRESS 2, RIGBY, ID 83442-5772
(208) 251-1032
(208) 745-8739
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
DME16726
ID
Other
Enumeration date
10/22/2011
Last updated
10/22/2011
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