Healthcare Provider Details

I. General information

NPI: 1417866302
Provider Name (Legal Business Name): EMMA GARRITSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4257 YELLOWSTONE AVE
CHUBBUCK ID
83202-2419
US

IV. Provider business mailing address

1285 W ELDREDGE RD
POCATELLO ID
83201-6064
US

V. Phone/Fax

Practice location:
  • Phone: 208-237-3940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberI75476
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: