Healthcare Provider Details

I. General information

NPI: 1942122452
Provider Name (Legal Business Name): CLINT DOTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 E FAIRVIEW AVE
MERIDIAN ID
83642-5848
US

IV. Provider business mailing address

3499 E FAIRVIEW AVE
MERIDIAN ID
83642-5848
US

V. Phone/Fax

Practice location:
  • Phone: 208-605-3755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7381627
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: