Provider Demographics
NPI:1962578526
Name:ALEXANDER DRUG INCORPORATED
Entity type:Organization
Organization Name:ALEXANDER DRUG INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAUSORO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-587-3346
Mailing Address - Street 1:490 N 2ND E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2729
Mailing Address - Country:US
Mailing Address - Phone:208-587-3346
Mailing Address - Fax:208-587-2052
Practice Address - Street 1:490 N 2ND E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2729
Practice Address - Country:US
Practice Address - Phone:208-587-3346
Practice Address - Fax:208-587-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID41265RP3336C0003X
ID542CP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002479600Medicaid
ID0252600001Medicare NSC