Provider Demographics
NPI:1891017208
Name:HB VENTURES RX LLC
Entity Type:Organization
Organization Name:HB VENTURES RX LLC
Other - Org Name:PORTICO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:208-288-4341
Mailing Address - Street 1:3355 E LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5047
Mailing Address - Country:US
Mailing Address - Phone:208-288-4341
Mailing Address - Fax:208-288-4374
Practice Address - Street 1:3355 E LOUISE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5047
Practice Address - Country:US
Practice Address - Phone:208-288-4341
Practice Address - Fax:208-288-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
ID2389RP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123967OtherPK