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General NPI Number Information
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NPI Number | 1780665463
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Entity Type | Organization
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Legal Business Name | RED CROSS PHARMACY INC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 509 E MAIN ST
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City | KENDRICK
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State | ID
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Zip | 83537-0131
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Country | US
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Telephone | 208-289-5941
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Fax | 208-289-5942
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Provider Business Mailing Address
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Address Line | PO BOX 131
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City | KENDRICK
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State | ID
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Zip | 83537-0131
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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 | PHARMACIST IN CHARGE
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Name | DANIEL EVERETT
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Credential | B PHARM
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Telephone | 208-289-5941
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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 | 865RP
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License Number State | ID
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