Healthcare Provider Details

I. General information

NPI: 1316216773
Provider Name (Legal Business Name): MICHAEL ALFRED BIDDLE JR. PHARM.D., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARK BLVD
BOISE ID
83712-7791
US

IV. Provider business mailing address

4830 W GREENBRIER DR
BOISE ID
83705-3623
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-4100
  • Fax: 208-381-4101
Mailing address:
  • Phone: 304-638-6994
  • Fax: 802-654-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7472
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: