Healthcare Provider Details

I. General information

NPI: 1942637335
Provider Name (Legal Business Name): PARKER R BROWN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 W STATE ST
BOISE ID
83714-6051
US

IV. Provider business mailing address

5446 N BEAHAM AVE
MERIDIAN ID
83646-5856
US

V. Phone/Fax

Practice location:
  • Phone: 208-853-0541
  • Fax:
Mailing address:
  • Phone: 208-244-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6790
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP6790
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: