Healthcare Provider Details

I. General information

NPI: 1033399571
Provider Name (Legal Business Name): SZE PHARMACEUTICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N 2ND ST
MCCALL ID
83638-3849
US

IV. Provider business mailing address

1001 N 2ND ST
MCCALL ID
83638-3849
US

V. Phone/Fax

Practice location:
  • Phone: 208-634-2433
  • Fax: 208-634-3125
Mailing address:
  • Phone: 208-634-2433
  • Fax: 208-634-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1946CP
License Number StateID

VIII. Authorized Official

Name: SZEWAN CHAN
Title or Position: CHIEF PHARMACIST
Credential: R.PH.
Phone: 208-634-2433