Healthcare Provider Details

I. General information

NPI: 1861780330
Provider Name (Legal Business Name): VICS FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MIDLAND BLVD
NAMPA ID
83686-2601
US

IV. Provider business mailing address

119 S VALLEY DR SUITE A # 120
NAMPA ID
83686-2974
US

V. Phone/Fax

Practice location:
  • Phone: 208-442-1000
  • Fax: 208-442-1091
Mailing address:
  • Phone: 208-465-7000
  • Fax: 208-465-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16667RP
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTOR ALLEN
Title or Position: OWNER
Credential:
Phone: 208-465-7000