Healthcare Provider Details

I. General information

NPI: 1740751627
Provider Name (Legal Business Name): FRANCES ANNA MAE BACONGUIS DYSINGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCES A BACONGUIS PHARMD

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W EMERALD ST
BOISE ID
83704-8737
US

IV. Provider business mailing address

6565 W EMERALD ST
BOISE ID
83704-8737
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-2512
  • Fax: 208-514-2513
Mailing address:
  • Phone: 208-514-2512
  • Fax: 208-514-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6136
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberP6136
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: