Healthcare Provider Details

I. General information

NPI: 1073133328
Provider Name (Legal Business Name): PRESCRIPTION PAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 S VANGUARD WAY
MERIDIAN ID
83642
US

IV. Provider business mailing address

PO BOX 509
FRUITLAND ID
83619-0509
US

V. Phone/Fax

Practice location:
  • Phone: 208-891-2192
  • Fax:
Mailing address:
  • Phone: 208-891-2192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TOTAL RX
Title or Position: OWNER
Credential: PHARMD
Phone: 208-452-7075