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General NPI Number Information
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NPI Number | 1922405786
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Entity Type | Individual
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Provider Name | MELISSA GILLEARD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 1012 CLEVELAND BLVD
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City | CALDWELL
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State | ID
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Zip | 83605-3852
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Country | US
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Telephone | 208-455-1792
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Fax | 208-459-2029
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Provider Business Mailing Address
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Address Line | 1323 S MAPLE GROVE RD
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City | BOISE
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State | ID
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Zip | 83709-1610
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Country | US
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Telephone | 208-319-0967
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Fax | 208-319-0970
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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 | P7162
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA-PHA-LIC-25266
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License Number State | MT
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