Healthcare Provider Details

I. General information

NPI: 1336817063
Provider Name (Legal Business Name): MADISON HILL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W HAYS ST
BOISE ID
83702-5511
US

IV. Provider business mailing address

5735 S ORCHID WAY
BOISE ID
83716-7019
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7092
  • Fax:
Mailing address:
  • Phone: 304-914-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP9581
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: