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General NPI Number Information
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NPI Number | 1558288027
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Entity Type | Individual
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Provider Name | RULON EPHRAIM SQUIRE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2026
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Last Update Date | 07/03/2026
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Provider Practice Location Address
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Address Line | 4921 S 5TH AVE
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City | POCATELLO
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State | ID
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Zip | 83204-2209
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Country | US
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Telephone | 623-606-7930
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 EASTPOINTE DR
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City | POCATELLO
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State | ID
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Zip | 83201-5159
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Country | US
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Telephone | 623-606-7930
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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 | P10841
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | 24939
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | P10841
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License Number State | ID
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