Healthcare Provider Details

I. General information

NPI: 1811305089
Provider Name (Legal Business Name): CASSANDRA CARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 N GOLFVIEW WAY
MERIDIAN ID
83646
US

IV. Provider business mailing address

1968 N GOLFVIEW WAY
MERIDIAN ID
83646-3946
US

V. Phone/Fax

Practice location:
  • Phone: 208-908-2984
  • Fax:
Mailing address:
  • Phone: 208-908-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4887
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberORRPH0015148
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP4887
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: