Organization
OSBURN DRUG CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD D LAVIGNE RPH (PRESIDENT)
(208) 556-1139
Entity
Organization
Contact information
Practice address
805 E MULLAN AVE., OSBURN, ID 83849-2170
(208) 556-1139
(208) 556-7311
Mailing address
PO BOX 2170, OSBURN, ID 83849-2170
(208) 556-1139
(208) 556-7311
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
245CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002450400
—
ID
Enumeration date
03/31/2006
Last updated
04/27/2010
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