Provider Demographics
NPI:1922870658
Name:IWL LLC
Entity Type:Organization
Organization Name:IWL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GEHRKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-331-6808
Mailing Address - Street 1:13965 W CHINDEN BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1457
Mailing Address - Country:US
Mailing Address - Phone:208-331-6808
Mailing Address - Fax:208-331-6800
Practice Address - Street 1:13965 W CHINDEN BLVD STE 208
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1457
Practice Address - Country:US
Practice Address - Phone:208-331-6808
Practice Address - Fax:208-331-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy