JACKS PHARMACY INC
103 E College Ave
St Maries, ID 83861
208-245-4578
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 3336C0003X | Suppliers - Pharmacy - Community/Retail Pharmacy | ID | 1368CP |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
002494500 | ID | MEDICAID | |
002494400 | ID | MEDICAID | |
NCPDP | 1303483 | ID | OTHER |