Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Bengal Pharmacy Arco
Organization subpart
No
Provider details
NPI number
Authorized official
RIKKI K TRUSSEL (PHARMACY MANAGER)
(208) 282-3407
Entity
Organization
Contact information
Practice address
551 HIGHLAND DR, ARCO, ID 83213-5003
(208) 527-8201
(208) 527-8273
Mailing address
990 S 8TH AVE STOP 8158, POCATELLO, ID 83209-0001
(208) 282-3407
(208) 282-6150
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992808059
—
ID
Enumeration date
09/06/2006
Last updated
04/05/2022
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