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General NPI Number Information
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NPI Number | 1609871474
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Entity Type | Individual
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Provider Name | WADE H FLOWERS JR. PHARM.D., BCPS, CGP
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-782-3770
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Fax | 208-782-3709
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Provider Business Mailing Address
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Address Line | 13103 W RESERVATION RD
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City | POCATELLO
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State | ID
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Zip | 83202-5129
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Country | US
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Telephone | 208-238-1281
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Fax | 208-782-3709
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | P4656
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | P4656
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License Number State | ID
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