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General NPI Number Information
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NPI Number | 1609430479
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Entity Type | Organization
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Legal Business Name | CONTINUED CARE LTC PHARMACY IDAHO LLC
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Dates
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Enumeration Date | 04/27/2019
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 9196 W EMERALD ST STE 125
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City | BOISE
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State | ID
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Zip | 83704-9049
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Country | US
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Telephone | 888-277-2132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1250
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City | RIVERTON
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State | UT
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Zip | 84065-1250
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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 | GENERAL MANAGER
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Name | BRANDON HAGEN
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Credential |
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Telephone | 888-557-4318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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