Healthcare Provider Details

I. General information

NPI: 1447252119
Provider Name (Legal Business Name): CHRISTOPHER TAFT OWENS PHARM.D.
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

845 W CENTER ST
POCATELLO ID
83204-4205
US

IV. Provider business mailing address

918 MARGARET ST
CHUBBUCK ID
83202-1648
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-6260
  • Fax:
Mailing address:
  • Phone: 208-238-3538
  • Fax: 208-282-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP5664
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: