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General NPI Number Information
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NPI Number | 1043760648
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Entity Type | Individual
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Provider Name | BRUCE WEBB PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 3250 E 17TH ST
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City | AMMON
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State | ID
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Zip | 83406-6758
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Country | US
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Telephone | 208-552-7677
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Fax | 208-552-2098
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Provider Business Mailing Address
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Address Line | 4715 STANFIELD LN
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7753
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Country | US
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Telephone | 208-552-7677
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Fax | 208-552-2098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | P6715
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License Number State | ID
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