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General NPI Number Information
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NPI Number | 1164804795
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Entity Type | Organization
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Legal Business Name | SAVEWAY MARKET INC
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1200 SHOUP ST
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City | SALMON
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State | ID
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Zip | 83467-4300
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Country | US
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Telephone | 208-756-2822
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | SALMON
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State | ID
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Zip | 83467-0640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. ALLISON CARDONA
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Credential | PHARMD
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Telephone | 208-240-1741
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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 | 39073RP
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License Number State | ID
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