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General NPI Number Information
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NPI Number | 1023010642
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Entity Type | Organization
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Legal Business Name | ST LUKE'S REG MED CTR EMPLOYEE OUTPT PHARMACY
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-4353
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Fax | 208-381-4355
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-4353
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Fax | 208-381-4355
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Authorized Official
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Title or Position | OPERATION MANAGER, OUTPT PHARMACY
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Name | JAMES W NORMARK
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Credential | RPH
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Telephone | 208-381-4354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 1019CP
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License Number State | ID
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