Healthcare Provider Details

I. General information

NPI: 1902068133
Provider Name (Legal Business Name): LINDSAY M BLACK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

7085 S EAGLE RD
MERIDIAN ID
83642-7217
US

V. Phone/Fax

Practice location:
  • Phone: 208-599-1441
  • Fax:
Mailing address:
  • Phone: 208-599-1441
  • Fax: 208-887-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP6176
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: