Healthcare Provider Details

I. General information

NPI: 1831278381
Provider Name (Legal Business Name): SUZANNE J HOPKINS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 E. BONNEVILLE
POCATELLO ID
83201
US

IV. Provider business mailing address

311 LA MONTAGNA STRADA
POCATELLO ID
83201-5800
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-3466
  • Fax: 208-234-9686
Mailing address:
  • Phone: 208-241-6475
  • Fax: 208-234-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberP5365
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: