Provider Demographics
NPI:1942340906
Name:B AND B DRUG INC
Entity Type:Organization
Organization Name:B AND B DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:TETSUO
Authorized Official - Last Name:KOMODA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-523-2277
Mailing Address - Street 1:2425 CHANNING WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8059
Mailing Address - Country:US
Mailing Address - Phone:208-523-2277
Mailing Address - Fax:208-552-1246
Practice Address - Street 1:2425 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8059
Practice Address - Country:US
Practice Address - Phone:208-523-2277
Practice Address - Fax:208-552-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID421CP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002304900Medicaid
ID002304900Medicaid