Provider Demographics
NPI:1770464711
Name:WELLNESS PEPTIDES
Entity type:Organization
Organization Name:WELLNESS PEPTIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:208-760-0557
Mailing Address - Street 1:324 BOISE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5576
Mailing Address - Country:US
Mailing Address - Phone:208-760-0557
Mailing Address - Fax:986-200-4697
Practice Address - Street 1:324 BOISE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5576
Practice Address - Country:US
Practice Address - Phone:208-760-0557
Practice Address - Fax:986-200-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy