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General NPI Number Information
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NPI Number | 1184727240
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Entity Type | Organization
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Legal Business Name | ROBERT LELAND COMSTOCK JR
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 23 SOUTH 8TH STREET SUITE 2
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City | ASHTON
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State | ID
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Zip | 83420
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Country | US
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Telephone | 208-652-3932
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Fax | 208-652-3470
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Provider Business Mailing Address
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Address Line | PO BOX 710
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City | ASHTON
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State | ID
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Zip | 83420-0710
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Country | US
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Telephone | 208-652-3932
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Fax | 208-652-3470
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Authorized Official
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Title or Position | OWNER
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Name | BOB COMSTOCK
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Credential | RPH
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Telephone | 208-652-3932
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1279RP
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License Number State | ID
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