Healthcare Provider Details

I. General information

NPI: 1285927848
Provider Name (Legal Business Name): HEIDI M POXLEITNER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W PULLMAN RD
MOSCOW ID
83843-4014
US

IV. Provider business mailing address

1810 W PULLMAN RD
MOSCOW ID
83843-4014
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-3583
  • Fax: 208-883-8280
Mailing address:
  • Phone: 208-882-3583
  • Fax: 208-883-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6081
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00065291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: