Healthcare Provider Details

I. General information

NPI: 1093702227
Provider Name (Legal Business Name): RICHARD ALLAN DE BLAQUIERE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5453 HIGHWAY 2
PRIEST RIVER ID
83856
US

IV. Provider business mailing address

702 S LINCOLN AVE
SANDPOINT ID
83864-9023
US

V. Phone/Fax

Practice location:
  • Phone: 208-448-1633
  • Fax: 208-448-1728
Mailing address:
  • Phone: 208-263-9080
  • Fax: 208-255-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5817
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: