Provider Demographics
NPI:1710525829
Name:FULL CIRCLE HEALTH, INC.
Entity Type:Organization
Organization Name:FULL CIRCLE HEALTH, INC.
Other - Org Name:FULL CIRCLE HEALTH PHARMACY MERIDIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-514-2500
Mailing Address - Street 1:777 N RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9251
Mailing Address - Country:US
Mailing Address - Phone:208-514-2500
Mailing Address - Fax:
Practice Address - Street 1:2275 S EAGLE RD STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2620
Practice Address - Country:US
Practice Address - Phone:209-954-8722
Practice Address - Fax:208-954-8723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULL CIRCLE HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy