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General NPI Number Information
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NPI Number | 1922870658
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Entity Type | Organization
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Legal Business Name | IWL LLC
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 13965 W CHINDEN BLVD STE 208
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City | BOISE
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State | ID
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Zip | 83713-1457
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Country | US
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Telephone | 208-331-6808
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Fax | 208-331-6800
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Provider Business Mailing Address
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Address Line | 13965 W CHINDEN BLVD STE 208
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City | BOISE
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State | ID
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Zip | 83713-1457
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Country | US
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Telephone | 208-331-6808
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Fax | 208-331-6800
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. JOSHUA WILLIAM GEHRKE
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Credential | PHARM.D
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Telephone | 208-331-6808
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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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