Healthcare Provider Details

I. General information

NPI: 1023237583
Provider Name (Legal Business Name): CATHERINE A GUNDLACH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST INPATIENT PHARMACY
BOISE ID
83712-6241
US

IV. Provider business mailing address

190 E BANNOCK ST INPATIENT PHARMACY
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2476
  • Fax: 208-381-3554
Mailing address:
  • Phone: 208-381-2476
  • Fax: 208-381-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP5193
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: