Provider Demographics
NPI:1457874612
Name:DJ GARDEN VALLEY PHARMACY INC
Entity type:Organization
Organization Name:DJ GARDEN VALLEY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-901-8006
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:208-901-8006
Mailing Address - Fax:208-901-8007
Practice Address - Street 1:284 VILLAGE CIR STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN VALLEY
Practice Address - State:ID
Practice Address - Zip Code:83622-8038
Practice Address - Country:US
Practice Address - Phone:208-901-8006
Practice Address - Fax:208-901-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy