Healthcare Provider Details

I. General information

NPI: 1518969328
Provider Name (Legal Business Name): TAMI MONICA STONE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

411 14TH AVE S
NAMPA ID
83651-4217
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-4353
  • Fax: 208-381-4355
Mailing address:
  • Phone: 208-447-7180
  • Fax: 208-381-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT2056
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: