Healthcare Provider Details

I. General information

NPI: 1538157565
Provider Name (Legal Business Name): REBECCA J SMITH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10464 GARVERDALE CT STE 706
BOISE ID
83704-5410
US

IV. Provider business mailing address

2700 GOURLEY ST
BOISE ID
83705-4020
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1259
  • Fax:
Mailing address:
  • Phone: 208-484-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5362
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP5362
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: