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General NPI Number Information
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NPI Number | 1699763029
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Entity Type | Organization
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Legal Business Name | ROSAUERS SUPERMARKETS INC
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 411 N MAIN ST
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City | MOSCOW
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State | ID
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Zip | 83843-2630
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Country | US
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Telephone | 208-882-0900
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Fax | 208-883-1407
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Provider Business Mailing Address
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Address Line | PO BOX 9000
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City | SPOKANE
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State | WA
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Zip | 99209-9000
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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 | PREES
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Name | JEFFRY PHILIPPS
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Credential | RPH
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Telephone | 509-326-8900
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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 | 1022CP
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License Number State | ID
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