Healthcare Provider Details

I. General information

NPI: 1356778963
Provider Name (Legal Business Name): LYNETTE MARIE REPACI PHARM D, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 W FRANKLIN RD
BOISE ID
83705-1109
US

IV. Provider business mailing address

5230 W FRANKLIN RD
BOISE ID
83705-1109
US

V. Phone/Fax

Practice location:
  • Phone: 208-429-6433
  • Fax: 208-429-6427
Mailing address:
  • Phone: 208-483-6433
  • Fax: 208-429-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP-5146
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: