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General NPI Number Information
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NPI Number | 1902149180
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Entity Type | Organization
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Legal Business Name | R & J PHARMACY, INC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 1441 PARKWAY DR
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City | BLACKFOOT
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State | ID
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Zip | 83221-1667
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Country | US
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Telephone | 208-684-7011
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Fax |
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Provider Business Mailing Address
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Address Line | 69 N PINE ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2053
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Country | US
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Telephone | 208-785-3510
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Fax | 208-785-7317
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT N MILLER
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Credential | PHARM-D
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Telephone | 208-785-3510
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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 | FP3773567
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License Number State | ID
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