Healthcare Provider Details

I. General information

NPI: 1568298610
Provider Name (Legal Business Name): MAREN HARRIS PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BUE LAKES BLVD N
TWIN FALLS ID
83301
US

IV. Provider business mailing address

2100 ALAN ST STE 2
IDAHO FALLS ID
83404-5801
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-5373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number6361477
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: