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Contact Information

IDAHO STATE UNIVERSITY
990 SOUTH 8TH
POCATELLO, ID83209
 Phone: 208-282-3407
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinic Pharmacy

3336C0002X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for IDAHO STATE UNIVERSITY

NPI Number 1730351081
LBN Legal business name IDAHO STATE UNIVERSITY
Authorized official GINA DAVIS - (PHARMACY MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/27/2008
Last updated 02/03/2012 - About 14 years ago
Identifiers
ID License # 349CP
Other 1307974 NCPDP PROVIDER IDENTIFICATION NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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