Healthcare Provider Details

I. General information

NPI: 1114370319
Provider Name (Legal Business Name): WHITNEY LAUREN HURT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 S ASHLEE PL
MERIDIAN ID
83642-2489
US

IV. Provider business mailing address

1280 S ASHLEE PL
MERIDIAN ID
83642-2489
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-7966
  • Fax:
Mailing address:
  • Phone: 208-755-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP7559
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: