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General NPI Number Information
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NPI Number | 1356367486
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Entity Type | Organization
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Legal Business Name | ED SNELL'S PHARMACY SHOP
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 1015 E YOUNG ST
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City | POCATELLO
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State | ID
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Zip | 83201-5282
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Country | US
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Telephone | 208-232-0049
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Fax | 208-232-3963
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Provider Business Mailing Address
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Address Line | 1015 E YOUNG ST
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City | POCATELLO
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State | ID
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Zip | 83201-5282
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Country | US
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Telephone | 208-232-0049
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Fax | 208-232-3963
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ED SNELL
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Credential | RPH, CCN
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Telephone | 208-232-0049
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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 | P4033
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License Number State | ID
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