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General NPI Number Information
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NPI Number | 1285355529
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Entity Type | Individual
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Provider Name | JOSEPH WEATHERSPOON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 1210 NW 16TH ST
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City | FRUITLAND
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State | ID
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Zip | 83619-2202
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Country | US
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Telephone | 208-452-8700
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Fax | 208-452-8701
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Provider Business Mailing Address
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Address Line | 1210 NW 16TH ST
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City | FRUITLAND
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State | ID
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Zip | 83619-2202
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Country | US
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Telephone | 208-452-8700
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Fax | 208-452-8701
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P6954
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License Number State | ID
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