Healthcare Provider Details

I. General information

NPI: 1497751234
Provider Name (Legal Business Name): PRESTON DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/07/2023
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 N 1ST E
PRESTON ID
83263-1325
US

IV. Provider business mailing address

39 N 1ST E
PRESTON ID
83263-1325
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-1563
  • Fax: 208-852-1268
Mailing address:
  • Phone: 208-852-1563
  • Fax: 208-852-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP3954
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH W HASLAM
Title or Position: PHARMACIST OWNER
Credential: PHARMD
Phone: 208-852-1563