Healthcare Provider Details

I. General information

NPI: 1043500515
Provider Name (Legal Business Name): MICHAEL WILLIAM LOVE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W STATE ST
BOISE ID
83702-4039
US

IV. Provider business mailing address

1515 W STATE ST
BOISE ID
83702-4039
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-7684
  • Fax: 208-336-5391
Mailing address:
  • Phone: 208-345-7684
  • Fax: 208-336-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP4862
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: