Healthcare Provider Details

I. General information

NPI: 1972733863
Provider Name (Legal Business Name): JUDI ANN EAMES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2009
Last Update Date: 07/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 BLUE LAKES BLVD N
TWIN FALLS ID
83301-4827
US

IV. Provider business mailing address

306 BLUE LAKES BLVD N
TWIN FALLS ID
83301-4827
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-4053
  • Fax: 208-734-4295
Mailing address:
  • Phone: 208-734-4053
  • Fax: 208-734-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5093
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: