Healthcare Provider Details

I. General information

NPI: 1174433403
Provider Name (Legal Business Name): AMBER HOOPER
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: AMBER MARTIN

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W MAIN ST
GRANGEVILLE ID
83530-1932
US

IV. Provider business mailing address

146 W MAIN ST
GRANGEVILLE ID
83530-1932
US

V. Phone/Fax

Practice location:
  • Phone: 208-983-1090
  • Fax:
Mailing address:
  • Phone: 208-983-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7281420
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: