MEDICARE: MRS. NANCY A LINDBERG RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	P4638	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124314927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY A LINDBERG RPH

Provider Business Mailing Address
First Line	:	415 CLEVELAND BLVD
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-3627
Country	:	US
Telephone Number	:	208-459-0521
Fax Number	:	208-459-8506

Provider Business Practice Location Address
First Line	:	415 CLEVELAND BLVD
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-3627
Country	:	US
Telephone Number	:	208-459-0521
Fax Number	:	208-459-8506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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