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General NPI Number Information
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NPI Number | 1043629397
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Entity Type | Organization
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Legal Business Name | TETON CLINICAL PHARMACY, INC.
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 1855 W BROADWAY ST
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3043
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Country | US
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Telephone | 208-529-3638
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Fax | 208-529-1715
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Provider Business Mailing Address
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Address Line | 1855 W BROADWAY ST
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3043
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Country | US
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Telephone | 208-529-3638
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Fax | 208-529-1715
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP HARPER
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Credential | DMD
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Telephone | 208-360-1317
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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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