Modern Compounding Pharmacy
NPI #1891830550 in Montpelier, Idaho
Provider Information
- NPI Number
- 1891830550
- Entity Type
- Organization
- Organization Name
- Modern Compounding Pharmacy
- Primary Specialty
- Pharmacy - Compounding Pharmacy
- Enumeration Date
- Feb 20, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 762 WASHINGTON ST
- City
- Montpelier
- State
- Idaho
- ZIP Code
- 83254-1422
- Phone
- (208) 847-0060
Authorized Official
- Name
- MR. HAROLD A OLSON, PH
- Title
- PRESIDENT
- Phone
- (208) 847-0060
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy - Compounding Pharmacy — Compounding Pharmacy |
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