Provider Demographics
NPI:1053012708
Name:PHARMACY SHOP INC
Entity type:Organization
Organization Name:PHARMACY SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDENT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RANAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-232-0049
Mailing Address - Street 1:1017 E YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5237
Mailing Address - Country:US
Mailing Address - Phone:208-232-0049
Mailing Address - Fax:208-232-3963
Practice Address - Street 1:1017 E YOUNG ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5237
Practice Address - Country:US
Practice Address - Phone:208-232-0049
Practice Address - Fax:208-232-3963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMACY SHOP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy