Provider Demographics
NPI:1912073552
Name:DARSONS GROUP INC
Entity Type:Organization
Organization Name:DARSONS GROUP INC
Other - Org Name:CHATEAU DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-726-5696
Mailing Address - Street 1:PO BOX 9200
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-7143
Mailing Address - Country:US
Mailing Address - Phone:208-726-2596
Mailing Address - Fax:208-726-8268
Practice Address - Street 1:451 4TH ST E
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-9401
Practice Address - Country:US
Practice Address - Phone:208-726-2596
Practice Address - Fax:208-726-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ID2146RP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807709200Medicaid
2020092OtherPK