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General NPI Number Information
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NPI Number | 1750786356
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Entity Type | Organization
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Legal Business Name | LATAH COMMUNITY HEALTH PHARMACY
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 803 S MAIN ST STE 120
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City | MOSCOW
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State | ID
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Zip | 83843-3043
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Country | US
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Telephone | 208-848-8312
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Fax | 208-882-5606
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Provider Business Mailing Address
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Address Line | 731 N IRON BRIDGE WAY
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City | SPOKANE
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State | WA
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Zip | 99202-4926
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Country | US
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Telephone | 509-444-8888
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AARON WILSON
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Credential |
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Telephone | 509-444-8888
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 37042RP
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License Number State | ID
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