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General NPI Number Information
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NPI Number | 1508558479
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Entity Type | Individual
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Provider Name | ISAAC MCCONNELL
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 2107 BLAINE ST
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City | CALDWELL
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State | ID
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Zip | 83605
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Country | US
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Telephone | 208-455-1094
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Fax | 208-455-1097
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Provider Business Mailing Address
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Address Line | 2107 BLAINE ST
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City | CALDWELL
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State | ID
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Zip | 83605-4427
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Country | US
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Telephone | 208-455-1094
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Fax | 208-455-1097
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | T2300
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License Number State | ID
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