Provider Demographics
NPI:1073133328
Name:PRESCRIPTION PAD LLC
Entity Type:Organization
Organization Name:PRESCRIPTION PAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-452-7075
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-0509
Mailing Address - Country:US
Mailing Address - Phone:208-891-2192
Mailing Address - Fax:
Practice Address - Street 1:885 S VANGUARD WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-891-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PRESCRIPTION PAD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-16
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy