Healthcare Provider Details

I. General information

NPI: 1255159802
Provider Name (Legal Business Name): BMH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 HOSPITAL WAY BLDG D
POCATELLO ID
83201-5091
US

IV. Provider business mailing address

1151 HOSPITAL WAY BLDG D
POCATELLO ID
83201-5091
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-3252
  • Fax: 208-785-9493
Mailing address:
  • Phone: 208-232-3252
  • Fax: 208-785-9493

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: JACOB ERICKSON
Title or Position: CEO
Credential:
Phone: 208-785-3801