Provider Demographics
NPI:1497751234
Name:PRESTON DRUG INC
Entity Type:Organization
Organization Name:PRESTON DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-852-1563
Mailing Address - Street 1:39 N 1ST E
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1325
Mailing Address - Country:US
Mailing Address - Phone:208-852-1563
Mailing Address - Fax:208-852-1268
Practice Address - Street 1:39 N 1ST E
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1325
Practice Address - Country:US
Practice Address - Phone:208-852-1563
Practice Address - Fax:208-852-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP3954183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1303572OtherNABP NUMBER
ID60018RPOtherSTATE LICENSE
FP9875557OtherDEA REGISTRATION
ID60018RPOtherSTATE LICENSE
IDAP9198892OtherDEA NUMBER