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General NPI Number Information
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NPI Number | 1750849832
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Entity Type | Individual
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Provider Name | ROBERT JAY ANDERSON PHARMD, RPH.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 4605 ENTERPRISE WAY STE 102
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City | CALDWELL
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State | ID
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Zip | 83605-6889
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Country | US
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Telephone | 208-855-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 675 BECK RD
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City | NYSSA
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State | OR
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Zip | 97913-5119
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Country | US
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Telephone | 208-680-5786
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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 | P8202
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License Number State | ID
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