Healthcare Provider Details

I. General information

NPI: 1174413439
Provider Name (Legal Business Name): MAY ALSANEA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST
BOISE ID
83712-6267
US

IV. Provider business mailing address

100 E IDAHO ST
BOISE ID
83712-6267
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3471564
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: