Provider Demographics
NPI:1225668957
Name:CHEMIST PRIME LLC
Entity Type:Organization
Organization Name:CHEMIST PRIME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-287-4667
Mailing Address - Street 1:222 N MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8239
Mailing Address - Country:US
Mailing Address - Phone:208-287-4667
Mailing Address - Fax:208-287-4668
Practice Address - Street 1:222 N MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8239
Practice Address - Country:US
Practice Address - Phone:208-287-4667
Practice Address - Fax:208-287-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy