Provider Demographics
NPI:1124021456
Name:PRESCRIPTION CENTER, LLC
Entity Type:Organization
Organization Name:PRESCRIPTION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:NED
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLYARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-709-4571
Mailing Address - Street 1:2252 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7552
Mailing Address - Country:US
Mailing Address - Phone:208-523-3360
Mailing Address - Fax:208-523-3387
Practice Address - Street 1:2252 CORONADO ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7552
Practice Address - Country:US
Practice Address - Phone:208-523-3360
Practice Address - Fax:208-523-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002296800Medicaid
ID002296700Medicaid