Organization
MAAG PRESCRIPTION CENTER LLC
Active
Other names
Maag Prescription & Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN CAROL MAAG (CFO/OWNER)
(208) 233-2063
Entity
Organization
Contact information
Practice address
333 W. CENTER ST., POCATELLO, ID 83204
(208) 233-2063
(208) 233-6158
Mailing address
PO BOX 115, POCATELLO, ID 83204-0115
(208) 233-2063
(208) 233-6158
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
526CP
ID
3336C0004X
Compounding Pharmacy
526CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002488900
—
ID
01
—
526CP
ST. BOARD OF PHARMACY #
ID
Enumeration date
03/07/2007
Last updated
03/07/2023
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