Healthcare Provider Details

I. General information

NPI: 1245150309
Provider Name (Legal Business Name): JACQUELINE HULCE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 MICHIGAN AVE
OROFINO ID
83544-9005
US

IV. Provider business mailing address

PO BOX 1490
OROFINO ID
83544-1490
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9881917
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: