=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730522244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY SCOTT HOGUE PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2013
-----------------------------------------------------
Last Update Date | 11/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 HIGHWAY 16
-----------------------------------------------------
City | EMMETT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83617-9427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-899-1528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1310 CIMARRON CT
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83644-5894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-899-1528
-----------------------------------------------------
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 | IDP7191
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------