Healthcare Provider Details

I. General information

NPI: 1487336525
Provider Name (Legal Business Name): FALLYN RAY LAMBERTSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S CLARK ST
RIGBY ID
83442-1407
US

IV. Provider business mailing address

12000 S SUNRISE CIR
IDAHO FALLS ID
83404-7840
US

V. Phone/Fax

Practice location:
  • Phone: 208-745-9201
  • Fax:
Mailing address:
  • Phone: 208-881-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP10847
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: