Organization
MEDICAL CLINIC PHARMACY INC
Active
Other names
Medical Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER HIGGINS (PRESIDENT)
(208) 459-1503
Entity
Organization
Contact information
Practice address
315 E ELM ST, SUITE150, CALDWELL, ID 83605-4857
(208) 459-1503
(208) 459-1504
Mailing address
315 E ELM ST, SUITE150, CALDWELL, ID 83605-4857
(208) 459-1503
(208) 459-1504
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2373RP
ID
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962581652
—
ID
01
—
2123594
PK
—
Enumeration date
11/03/2006
Last updated
09/19/2025
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