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General NPI Number Information
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NPI Number | 1770833931
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Entity Type | Individual
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Provider Name | ROBERT W GEDDES PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 250 E PARKCENTER BLVD
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City | BOISE
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State | ID
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Zip | 83706-3940
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Country | US
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Telephone | 208-513-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 4996 N BOTTICELLI AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-6740
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Country | US
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Telephone |
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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 | P6687
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License Number State | ID
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