National Provider Identifier Database

STATE OF IDAHO
Pharmacy

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.


Contact Information

STATE OF IDAHO
700 EAST ALICE STREET
BLACKFOOT, ID83221
Phone: 208-785-1200
Fax: 208-785-8424
Website:
Specialty Taxonomy Code
* Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X

* Indicates primary specialty

NPI Profile & details for STATE OF IDAHO

NPI Number 1750442315
Legal business name
LBN
STATE OF IDAHO
Authorized official TRACEY SESSIONS - (ADMINISTRATIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 12/13/2006
Last updated 06/16/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • ID License #: 462HP
  • ID Medicaid: 002825500
  • ID Medicaid: 002835700
  • ID Other: 1302772 NABP & NCPDP

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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