Healthcare Provider Details

I. General information

NPI: 1821372384
Provider Name (Legal Business Name): TONY WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MCKINLEY AVE
KELLOGG ID
83837-2693
US

IV. Provider business mailing address

7842 BANNING LN
COEUR D ALENE ID
83815-5228
US

V. Phone/Fax

Practice location:
  • Phone: 208-786-9303
  • Fax: 208-783-4302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6250
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: