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General NPI Number Information
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NPI Number | 1134922339
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Entity Type | Organization
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Legal Business Name | ST LUKES REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 11801 W EXECUTIVE DR
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City | BOISE
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State | ID
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Zip | 83713-0803
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Country | US
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Telephone | 208-205-7779
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Fax | 208-205-7780
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | BOISE
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State | ID
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Zip | 83701-0640
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Country | US
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Telephone | 208-205-7779
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Fax | 208-205-7780
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Authorized Official
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Title or Position | CHIEF PHARMACY OFFICER
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Name | KELLEY CURTIS
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Credential |
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Telephone | 208-493-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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