Healthcare Provider Details

I. General information

NPI: 1760386635
Provider Name (Legal Business Name): IDAHO PHARMACY RETAIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8854 W EMERALD ST STE 140
BOISE ID
83704-4845
US

IV. Provider business mailing address

1079 S ANCONA AVE STE 140
EAGLE ID
83616-5539
US

V. Phone/Fax

Practice location:
  • Phone: 208-229-5539
  • Fax: 208-485-7400
Mailing address:
  • Phone: 208-229-5539
  • Fax: 208-485-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES J HUNT
Title or Position: MANAGING PARTNER
Credential: PHARMD
Phone: 208-229-5539