Healthcare Provider Details

I. General information

NPI: 1184438988
Provider Name (Legal Business Name): REED AUSTIN JEPPE PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 W EXECUTIVE DR
BOISE ID
83713-0803
US

IV. Provider business mailing address

11986 BONNIE LN
NAMPA ID
83651-8003
US

V. Phone/Fax

Practice location:
  • Phone: 208-205-7779
  • Fax:
Mailing address:
  • Phone: 208-697-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP9507
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: