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General NPI Number Information
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NPI Number | 1124785696
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Entity Type | Individual
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Provider Name | YAZMIN J FRODIN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 2250 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7552
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Country | US
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Telephone | 208-542-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 355 W HALLIDAY ST
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City | POCATELLO
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State | ID
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Zip | 83204-3440
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Country | US
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Telephone | 208-329-9919
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Fax |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | P9741
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License Number State | ID
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