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General NPI Number Information
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NPI Number | 1275245615
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Entity Type | Organization
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Legal Business Name | PRESTON DRUG HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 39 N 1ST E
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City | PRESTON
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State | ID
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Zip | 83263-1325
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Country | US
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Telephone | 208-852-1563
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Fax | 208-852-1268
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Provider Business Mailing Address
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Address Line | 39 N 1ST E
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City | PRESTON
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State | ID
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Zip | 83263-1325
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Country | US
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Telephone | 208-852-1563
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Fax | 208-852-1268
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Authorized Official
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Title or Position | OWNER
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Name | SETH HASLAM
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Credential | PHARMD
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Telephone | 208-851-1561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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