Provider Demographics
NPI:1346680683
Name:VETERANS PHARMA INCORPORATED
Entity Type:Organization
Organization Name:VETERANS PHARMA INCORPORATED
Other - Org Name:PREMIUM RX SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLYNEUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-323-1259
Mailing Address - Street 1:9196 W EMERALD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-0679
Mailing Address - Country:US
Mailing Address - Phone:208-323-1259
Mailing Address - Fax:208-323-5666
Practice Address - Street 1:9196 W EMERALD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0679
Practice Address - Country:US
Practice Address - Phone:208-323-1259
Practice Address - Fax:208-323-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy