Healthcare Provider Details

I. General information

NPI: 1851673453
Provider Name (Legal Business Name): CALVIN NEIL HURLEY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 N STATE ST
RIGBY ID
83442-1444
US

IV. Provider business mailing address

150 N STATE ST
RIGBY ID
83442-1443
US

V. Phone/Fax

Practice location:
  • Phone: 208-745-9201
  • Fax:
Mailing address:
  • Phone: 208-745-0267
  • Fax: 208-745-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP3933
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: