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General NPI Number Information
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NPI Number | 1922312842
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Entity Type | Organization
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Legal Business Name | TETON VALLEY HOSPITAL PHARMACY
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 120 EAST HOWARD AVE.
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City | DRIGGS
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State | ID
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Zip | 83422-5112
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Country | US
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Telephone | 208-354-2383
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Fax | 208-354-3158
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Provider Business Mailing Address
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Address Line | 120 EAST HOWARD AVE.
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City | DRIGGS
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State | ID
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Zip | 83422-5112
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Country | US
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Telephone | 208-354-2383
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Fax | 208-354-3158
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MRS. LAURA C PIQUET
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Credential |
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Telephone | 208-354-6302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 1340PA
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License Number State | ID
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