Healthcare Provider Details

I. General information

NPI: 1386237089
Provider Name (Legal Business Name): RACHEL DJURICH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 S 10TH AVE
CALDWELL ID
83605-5706
US

IV. Provider business mailing address

4110 S 10TH AVE
CALDWELL ID
83605-5706
US

V. Phone/Fax

Practice location:
  • Phone: 208-402-0154
  • Fax: 208-402-0160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8165
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: