Organization
BYU ID STUDENT HLTH CNTR PCHY
Active
Other names
BYU-IDAHO STUDENT HEALTH CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN ANDREASEN PHARMD RPH (PCHY DIR)
(208) 496-9330
Entity
Organization
Contact information
Practice address
179 STUDENT HLTH CTR, REXBURG, ID 83460-0001
(208) 496-9330
(208) 496-9343
Mailing address
179 STUDENT HLTH CTR, REXBURG, ID 83460-0001
(208) 496-9330
(208) 496-9343
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
614RP
ID
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020561
PK
—
Enumeration date
07/22/2006
Last updated
04/18/2017
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