Healthcare Provider Details

I. General information

NPI: 1396435509
Provider Name (Legal Business Name): G AND R INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MAIN ST
NYSSA OR
97913-3843
US

IV. Provider business mailing address

2790 W CHERRY LN STE 100
MERIDIAN ID
83642-1102
US

V. Phone/Fax

Practice location:
  • Phone: 541-372-2222
  • Fax: 541-372-2928
Mailing address:
  • Phone: 208-288-1496
  • Fax: 208-288-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEVIN R TRONE
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 208-288-1496