Provider Demographics
NPI:1578639233
Name:Z-INC
Entity Type:Organization
Organization Name:Z-INC
Other - Org Name:PAULS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZATICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-337-3919
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-0937
Mailing Address - Country:US
Mailing Address - Phone:208-454-1111
Mailing Address - Fax:208-454-1066
Practice Address - Street 1:425 N 10TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3402
Practice Address - Country:US
Practice Address - Phone:208-454-1111
Practice Address - Fax:208-454-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ID1558RP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021747OtherPK
ID805901600Medicaid
ID805901600Medicaid