=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366902926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOAA ALZAHRAA ALSOUDANI PHARM D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2019
-----------------------------------------------------
Last Update Date | 03/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 BLUE LAKES BLVD N
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-3374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-736-3321
-----------------------------------------------------
Fax | 208-944-3425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 CLEAR SPRINGS DR
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-0006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-320-3310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | P7948
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------