Healthcare Provider Details

I. General information

NPI: 1063326551
Provider Name (Legal Business Name): JOSEPH MAKUBUYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 YELLOWSTONE AVE
POCATELLO ID
83201-4416
US

IV. Provider business mailing address

211 CIRCLE INN DR TRLR 20
CHUBBUCK ID
83202-2316
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-2382
  • Fax:
Mailing address:
  • Phone: 208-419-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3481428
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: