Healthcare Provider Details

I. General information

NPI: 1790815561
Provider Name (Legal Business Name): JOSEPH R. INECK PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

100 E IDAHO ST MOUNTAIN STATES TUMOR INSTITUTE
BOISE ID
83712-6267
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax:
Mailing address:
  • Phone: 208-381-3108
  • Fax: 208-381-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6121
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP6053
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: