Provider Demographics
NPI:1285643353
Name:ATKINSONS MARKET, INC
Entity Type:Organization
Organization Name:ATKINSONS MARKET, INC
Other - Org Name:THE DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIASON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-788-9714
Mailing Address - Street 1:PO BOX 2700
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-2700
Mailing Address - Country:US
Mailing Address - Phone:208-788-9714
Mailing Address - Fax:208-788-2966
Practice Address - Street 1:91 E CROY ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8407
Practice Address - Country:US
Practice Address - Phone:208-788-9714
Practice Address - Fax:208-788-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1304601OtherNAPB
ID004329000Medicaid