Healthcare Provider Details

I. General information

NPI: 1447877824
Provider Name (Legal Business Name): CHELSEA ZIPSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N CURTIS RD
BOISE ID
83706-1309
US

IV. Provider business mailing address

12470 W PALM DR
BOISE ID
83713-5825
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-2772
  • Fax:
Mailing address:
  • Phone: 913-515-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP7778
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7778
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: