Healthcare Provider Details

I. General information

NPI: 1386930006
Provider Name (Legal Business Name): SHELLY MARIE OGAMI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 OVERLAND RD
BOISE ID
83705-2634
US

IV. Provider business mailing address

6105 EDGEWATER DR
BOISE ID
83709-1030
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-2827
  • Fax: 208-345-8448
Mailing address:
  • Phone: 208-322-3997
  • Fax: 208-345-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4561
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: