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General NPI Number Information
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NPI Number | 1699814574
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Entity Type | Organization
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Legal Business Name | BEAR LAKE COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 164 S 5TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-1630
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Fax | 208-847-4475
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Provider Business Mailing Address
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Address Line | 164 S 5TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-1630
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Fax | 208-847-4475
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MRS. LYNETTE DAWN WILLIAMS
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Credential | RPH
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Telephone | 208-847-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 555HP
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | HP555
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License Number State | ID
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