State Hospital South Pharmacy

LBN: State Of Idaho
State Hospital South Pharmacy is an health care organization with primary practice located at 700 East Alice Street , Blackfoot ID 83221. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Pharmacy is the primary health care specialty. State Of Idaho can be contacted via phone (208) 785-1200, or through Sessions, Tracey G. via phone (208) 785-8406.

Contact Information

Primary practice address
700 East Alice Street Blackfoot ID 83221
Phone: (208) 785-1200
Fax: (208) 785-8424
Website:
Map and Directions
Authorized official contact:
Name: Sessions, Tracey G.
Phone: (208) 785-8406

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 462HP Idaho
Suppliers / Long Term Care Pharmacy 3336L0003X 462HP Idaho

Profile Details

NPI number 1750442315
LBN Legal business name State Of Idaho
DBA Doing business as State Hospital South Pharmacy
Authorized official Sessions, Tracey G.
Entity Organization
Organization subpart 1 No
Enumeration date Dec 13th, 2006
Last updated Jun 16th, 2018 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750442315 NPPES
Idaho MEDICAID 002825500
Idaho MEDICAID 002835700
Idaho Other 1302772

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