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General NPI Number Information
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NPI Number | 1013559269
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Entity Type | Organization
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Legal Business Name | TIMBERLINE PHARMACY
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 4574 N TEN MILE RD STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-6930
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Country | US
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Telephone | 208-616-1722
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Fax | 208-616-1863
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Provider Business Mailing Address
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Address Line | PO BOX 171145
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City | SALT LAKE CITY
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State | UT
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Zip | 84117-1145
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Country | US
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Telephone | 801-828-7389
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JUSTIN MEIER
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Credential |
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Telephone | 801-828-7389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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