Healthcare Provider Details

I. General information

NPI: 1922646850
Provider Name (Legal Business Name): KARINA CARIDAD SOTERAS-CORTES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7282
  • Fax: 208-381-4355
Mailing address:
  • Phone: 208-381-7282
  • Fax: 208-381-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6451
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: