National Provider Identifier Database

IDAHO STATE UNIVERSITY
Clinic Pharmacy

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.


Contact Information

IDAHO STATE UNIVERSITY
990 SOUTH 8TH
POCATELLO, ID83209
Phone: 208-282-3407
Fax:
Website:
Specialty Taxonomy Code
* Clinic Pharmacy 3336C0002X

* Indicates primary specialty

NPI Profile & details for IDAHO STATE UNIVERSITY

NPI Number 1730351081
Legal business name
LBN
IDAHO STATE UNIVERSITY
Authorized official GINA DAVIS - (PHARMACY MANAGER)
Entity Organization
Organization subpart No
Enumeration date 03/27/2008
Last updated 02/03/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • ID License #: 349CP
  • Other: 1307974 NCPDP PROVIDER IDENTIFICATION NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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