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General NPI Number Information
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NPI Number | 1730242355
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Entity Type | Organization
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Legal Business Name | PENNY WISE DRUG STORES INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 802 CLEVELAND BLVD
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City | CALDWELL
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State | ID
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Zip | 83605-4149
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Country | US
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Telephone | 208-459-3691
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Fax | 208-459-0189
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | CALDWELL
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State | ID
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Zip | 83606-0278
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Country | US
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Telephone | 208-459-3691
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Fax | 208-459-0189
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Authorized Official
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Title or Position | SECE TREAS
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Name | THOMAS WILSON
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Credential |
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Telephone | 208-459-2134
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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 | 302RP
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License Number State | ID
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