Healthcare Provider Details

I. General information

NPI: 1891017208
Provider Name (Legal Business Name): HB VENTURES RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 E LOUISE DR
MERIDIAN ID
83642-5047
US

IV. Provider business mailing address

3355 E LOUISE DR
MERIDIAN ID
83642-5047
US

V. Phone/Fax

Practice location:
  • Phone: 208-288-4341
  • Fax: 208-288-4374
Mailing address:
  • Phone: 208-288-4341
  • Fax: 208-288-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2389RP
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATTI FEENEY
Title or Position: BUSINESS MANAGER
Credential: BBA
Phone: 208-288-4341