Healthcare Provider Details

I. General information

NPI: 1073780680
Provider Name (Legal Business Name): BARRY LYNN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 W STATE STREET
BOISE ID
83714
US

IV. Provider business mailing address

7020 W STATE ST
BOISE ID
83714-7419
US

V. Phone/Fax

Practice location:
  • Phone: 208-853-3503
  • Fax: 208-853-4328
Mailing address:
  • Phone: 208-853-3503
  • Fax: 208-853-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5425
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: