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General NPI Number Information
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NPI Number | 1053382770
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Entity Type | Organization
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Legal Business Name | ADVANCED INFUSION MEDICINE LLC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 627 N FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83713-8025
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Country | US
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Telephone | 208-376-2246
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Fax | 208-376-2249
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Provider Business Mailing Address
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Address Line | 627 N FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83713-8025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JAMES TANZINI
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Credential | RPH
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Telephone | 208-376-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 1980LS
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License Number State | ID
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