Healthcare Provider Details

I. General information

NPI: 1427050020
Provider Name (Legal Business Name): JAMES ALEXANDER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N 2ND E
MOUNTAIN HOME ID
83647-2725
US

IV. Provider business mailing address

270 N 2ND E
MOUNTAIN HOME ID
83647-2725
US

V. Phone/Fax

Practice location:
  • Phone: 208-587-3346
  • Fax: 208-587-2052
Mailing address:
  • Phone: 208-587-3346
  • Fax: 208-587-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP3807
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: