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NPI Code Detail

MEDICARE: ONTARIO PHARMACY INC

MEDICARE: ONTARIO PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336S0011XSpecialty Pharmacy
23336C0003XCommunity/Retail Pharmacy
33336C0004XCompounding Pharmacy21811LSID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12142790OTHERPK

General Provider Information

NPI Number : 1659700896
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONTARIO PHARMACY INC
Provider Business Mailing Address
First Line : 1118 NW 16TH ST # 150B
Second Line :
City : FRUITLAND
State : ID
Zip : 83619-2271
Country : US
Telephone Number : 208-452-3340
Fax Number : 208-452-7446
Provider Business Practice Location Address
First Line : 1118 NW 16TH ST # 150B
Second Line :
City : FRUITLAND
State : ID
Zip : 83619-2271
Country : US
Telephone Number : 208-452-3340
Fax Number : 208-452-7446
Authorized Official
Title or Position : PHARMACIST/OWNER
Name : ROBERT WHEATLEY
Credential :
Telephone Number : 208-452-3340
Provider Enumeration Date : 11/08/2013
Last Update Date : 03/19/2014

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Directions to “ONTARIO PHARMACY INC ” Practice Location

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