=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629795372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNNE SVEDIN PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2022
-----------------------------------------------------
Last Update Date | 10/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 E HAWAII AVE STE 160
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83686-6011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-466-7823
-----------------------------------------------------
Fax | 208-466-8429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7833 S ROBINSON RD
-----------------------------------------------------
City | MELBA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83641-6035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-919-5115
-----------------------------------------------------
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 | P5240
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------