Provider Demographics
NPI:1740391762
Name:WATKINS PHARMACY INC
Entity Type:Organization
Organization Name:WATKINS PHARMACY INC
Other - Org Name:MEDICAP PHARMACY 8440
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-382-4204
Mailing Address - Street 1:2790 W CHERRY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1102
Mailing Address - Country:US
Mailing Address - Phone:208-382-4204
Mailing Address - Fax:208-382-6362
Practice Address - Street 1:220 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:ID
Practice Address - Zip Code:83611
Practice Address - Country:US
Practice Address - Phone:208-382-4204
Practice Address - Fax:208-382-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDRDO72703OtherIDAHO BOARD OF PHARMACY
1300780OtherNCPDP
ID1740391762Medicaid