Organization
MODERN COMPOUNDING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HAROLD A OLSON PH (PRESIDENT)
(208) 847-0060
Entity
Organization
Contact information
Practice address
762 WASHINGTON ST, MONTPELIER, ID 83254-1422
(208) 847-0060
(208) 847-0090
Mailing address
762 WASHINGTON ST, MONTPELIER, ID 83254-1422
(208) 847-0060
(208) 847-0090
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
1661LS
ID
Other
Enumeration date
02/20/2007
Last updated
08/22/2020
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