Healthcare Provider Details

I. General information

NPI: 1538480264
Provider Name (Legal Business Name): SVETLANA BALINSCHI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SVETLANA NOZDRINA PHARMD

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 BLAINE ST.
CALDWELL ID
83605
US

IV. Provider business mailing address

808 HEARTLAND DR
NAMPA ID
83686
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number60120724
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: