Provider Demographics
NPI:1144910878
Name:NORCO, INC.
Entity type:Organization
Organization Name:NORCO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-509-3088
Mailing Address - Street 1:1125 W AMITY RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5412
Mailing Address - Country:US
Mailing Address - Phone:208-336-1643
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST # 105
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7243
Practice Address - Country:US
Practice Address - Phone:844-819-4907
Practice Address - Fax:833-726-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy