Healthcare Provider Details

I. General information

NPI: 1063240042
Provider Name (Legal Business Name): ALEXIS RAENELLE DAUNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD STE 1000
MERIDIAN ID
83642-6353
US

IV. Provider business mailing address

851 W FRONT ST APT 506
BOISE ID
83702-5827
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5252
  • Fax:
Mailing address:
  • Phone: 701-893-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI75615
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: