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General NPI Number Information
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NPI Number | 1447710728
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Entity Type | Individual
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Provider Name | ALYSSA RENAE ZIBROWSKI PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 07/20/2019
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Provider Practice Location Address
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Address Line | 149 W STATE ST STE 101
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City | EAGLE
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State | ID
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Zip | 83616-4911
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Country | US
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Telephone | 208-939-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 477 N WHITEWATER PARK BLVD APT C107
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City | BOISE
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State | ID
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Zip | 83702-5684
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Country | US
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Telephone | 309-721-4700
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 123392
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P8236
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License Number State | ID
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