Healthcare Provider Details

I. General information

NPI: 1164811402
Provider Name (Legal Business Name): ASHTON MEMORIAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S. 8TH ST.
ASHTON ID
83420
US

IV. Provider business mailing address

PO BOX 838
ASHTON ID
83420-0838
US

V. Phone/Fax

Practice location:
  • Phone: 208-652-3932
  • Fax:
Mailing address:
  • Phone: 208-652-7461
  • Fax: 208-652-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE NIELSEN
Title or Position: HR DIRECTOR
Credential:
Phone: 208-652-7461