Provider Demographics
NPI:1679713150
Name:SUN VALLEY PHARMACIES, INC
Entity type:Organization
Organization Name:SUN VALLEY PHARMACIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-232-0049
Mailing Address - Street 1:21 E MAPLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-4900
Mailing Address - Country:US
Mailing Address - Phone:208-788-3930
Mailing Address - Fax:208-788-1099
Practice Address - Street 1:21 E MAPLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-4900
Practice Address - Country:US
Practice Address - Phone:208-788-3930
Practice Address - Fax:208-788-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2306CP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy