Healthcare Provider Details

I. General information

NPI: 1336050608
Provider Name (Legal Business Name): DERMCARE & FAMILY MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PIER VIEW DR
IDAHO FALLS ID
83402-4972
US

IV. Provider business mailing address

900 PIER VIEW DR
IDAHO FALLS ID
83402-4972
US

V. Phone/Fax

Practice location:
  • Phone: 664-666-0303
  • Fax:
Mailing address:
  • Phone: 664-666-0303
  • Fax:

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: RUSELL DAVIS
Title or Position: MANAGER
Credential:
Phone: 664-666-0303