Healthcare Provider Details

I. General information

NPI: 1104578731
Provider Name (Legal Business Name): HEATHER SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 2ND ST S
NAMPA ID
83651-3700
US

IV. Provider business mailing address

50 2ND ST S
NAMPA ID
83651-3700
US

V. Phone/Fax

Practice location:
  • Phone: 208-465-2836
  • Fax: 208-465-2833
Mailing address:
  • Phone: 208-465-2836
  • Fax: 208-465-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP9883
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: