Healthcare Provider Details

I. General information

NPI: 1215511027
Provider Name (Legal Business Name): BRIAN NOCITO DO, PHARMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1986 W HAYDEN AVE
HAYDEN ID
83835-7412
US

IV. Provider business mailing address

1986 W HAYDEN AVE
HAYDEN ID
83835-7412
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-7760
  • Fax: 208-762-7740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1381229
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: