Healthcare Provider Details

I. General information

NPI: 1306610084
Provider Name (Legal Business Name): JADEN WOOD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

10892 W POPPY ST
BOISE ID
83713-5100
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5255
  • Fax:
Mailing address:
  • Phone: 208-861-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP11020
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: