| Organization Name: | THE HOSPICE STORE AND SUPPLIES |
| NPI Number: | 1851677827 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAWN KARL BOSH (OWNER/MANAGER) |
| Mailing Address: | 134 N 3966 E Address 2 Rigby |
| State: | ID US |
| Postal Code: | 834425772 |
| Phone Number: | 2082511032 |
| Fax Number: | 2087458739 |
| NPI Enumeration Date: | 10/22/2011 |
| NPI Last Update Date: | 10/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | DME16726 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |