Healthcare Provider Details

I. General information

NPI: 1285643353
Provider Name (Legal Business Name): ATKINSONS MARKET, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 E CROY ST
HAILEY ID
83333-8407
US

IV. Provider business mailing address

PO BOX 2700
HAILEY ID
83333-2700
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-9714
  • Fax: 208-788-2966
Mailing address:
  • Phone: 208-788-9714
  • Fax: 208-788-2966

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: HEIDI ELIASON
Title or Position: PHARMACIST
Credential: RPH
Phone: 208-788-9714