Provider Demographics
NPI:1790321321
Name:SAWTOOTH COMPOUNDING PHARMACY, LLC
Entity Type:Organization
Organization Name:SAWTOOTH COMPOUNDING PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:EDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:208-506-2673
Mailing Address - Street 1:90 S COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0930
Mailing Address - Country:US
Mailing Address - Phone:208-506-2673
Mailing Address - Fax:208-506-2672
Practice Address - Street 1:90 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0930
Practice Address - Country:US
Practice Address - Phone:208-506-2673
Practice Address - Fax:208-506-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID2405OtherSAWTOOTH