Healthcare Provider Details

I. General information

NPI: 1609149665
Provider Name (Legal Business Name): MATTHEW PATRICK RONAYNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 S FEDERAL WAY STE 104
BOISE ID
83705-5228
US

IV. Provider business mailing address

3527 S FEDERAL WAY STE 104
BOISE ID
83705-5228
US

V. Phone/Fax

Practice location:
  • Phone: 208-424-7588
  • Fax: 208-424-7581
Mailing address:
  • Phone: 208-424-7588
  • Fax: 208-424-7581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00020307
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: