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General NPI Number Information
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NPI Number | 1033382304
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Entity Type | Organization
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Legal Business Name | PORTICO PHARMACY
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 3355 E LOUISE ST
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-288-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 3355 E LOUISE ST
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-288-4341
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. ROBERT EUGENE FLOTO
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Credential | PHARMACIST
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Telephone | 208-288-4341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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