Healthcare Provider Details

I. General information

NPI: 1376908616
Provider Name (Legal Business Name): ZHEN RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3395 S FEDERAL WAY
BOISE ID
83705-5217
US

IV. Provider business mailing address

3395 S FEDERAL WAY
BOISE ID
83705-5217
US

V. Phone/Fax

Practice location:
  • Phone: 208-319-1043
  • Fax:
Mailing address:
  • Phone: 208-319-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7427
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: