Healthcare Provider Details

I. General information

NPI: 1770833931
Provider Name (Legal Business Name): ROBERT W GEDDES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E PARKCENTER BLVD
BOISE ID
83706-3940
US

IV. Provider business mailing address

4996 N BOTTICELLI AVE
MERIDIAN ID
83646-6740
US

V. Phone/Fax

Practice location:
  • Phone: 208-513-3470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6687
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: