| |
150 N State St Rigby ID 83442-1443 | |
(208) 745-0267 | |
(208) 745-0208 |
Full Name | |
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Speciality | Pharmacy |
Location | 150 N State St, Rigby, Idaho |
Authorized Official Name and Position | Marcus C Hurst (PHARMACY SUPERVISOR) |
Authorized Official Contact | 2087459201 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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182 N State St Rigby ID 83442-1444 Ph: (208) 745-9201 | 150 N State St Rigby ID 83442-1443 Ph: (208) 745-0267 |
NPI Number | 1720132178 |
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Provider Enumeration Date | 01/23/2007 |
Last Update Date | 11/19/2024 |
Medicare PECOS PAC ID | 5890966691 |
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Medicare Enrollment ID | O20110928000334 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720132178 | NPI | - | NPPES |
1305831 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
1720132178 | Medicaid | ID | |
1912011 | Other | ID | MEDICARE NORIDIAN |
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