Healthcare Provider Details

I. General information

NPI: 1720536758
Provider Name (Legal Business Name): MATTHEW LORCHER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 CLEVELAND BLVD
CALDWELL ID
83605-4443
US

IV. Provider business mailing address

4612 W CROWLEY DR
MERIDIAN ID
83646-6469
US

V. Phone/Fax

Practice location:
  • Phone: 208-455-1094
  • Fax: 208-455-1097
Mailing address:
  • Phone: 208-890-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7588
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: