Provider Demographics
NPI:1437145240
Name:SUPER SAVE HIGHLAND PHARMACY
Entity Type:Organization
Organization Name:SUPER SAVE HIGHLAND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TORI
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-232-9392
Mailing Address - Street 1:755 HOSPITAL WAY B1
Mailing Address - Street 2:P O BOX 4869
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4869
Mailing Address - Country:US
Mailing Address - Phone:208-237-9393
Mailing Address - Fax:208-237-6017
Practice Address - Street 1:755 HOSPITAL WAY
Practice Address - Street 2:SUITE B1
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4869
Practice Address - Country:US
Practice Address - Phone:208-237-9393
Practice Address - Fax:208-237-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11537CP332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies