Healthcare Provider Details

I. General information

NPI: 1962573444
Provider Name (Legal Business Name): MICHAEL S. HESS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 PINE ST
POTLATCH ID
83855
US

IV. Provider business mailing address

3109 W TWIN RD
MOSCOW ID
83843-8129
US

V. Phone/Fax

Practice location:
  • Phone: 208-875-1212
  • Fax: 208-875-0859
Mailing address:
  • Phone: 208-882-4075
  • Fax: 208-875-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4155
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: