Healthcare Provider Details

I. General information

NPI: 1912420209
Provider Name (Legal Business Name): JENNIFER RUWO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W OVERLAND RD
BOISE ID
83705-2634
US

IV. Provider business mailing address

5100 W OVERLAND RD
BOISE ID
83705-2634
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-1696
  • Fax:
Mailing address:
  • Phone: 208-343-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7788
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: