Healthcare Provider Details

I. General information

NPI: 1790123545
Provider Name (Legal Business Name): JENNI BUU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

4937 N POINT PL
BOISE ID
83703-6407
US

V. Phone/Fax

Practice location:
  • Phone: 208-577-8517
  • Fax:
Mailing address:
  • Phone: 208-577-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6676
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8341110-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: