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NPI Code Detail

MEDICARE: NOE RONQUILLO

MEDICARE: NOE RONQUILLO
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
1183500000XPharmacist9161670ID

General Provider Information

NPI Number : 1700616265
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOE RONQUILLO
Provider Business Mailing Address
First Line : 391 N MIRA AVE
Second Line :
City : STAR
State : ID
Zip : 83669-5423
Country : US
Telephone Number : 208-284-1806
Fax Number :
Provider Business Practice Location Address
First Line : 5425 W CHINDEN BLVD
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1468
Country : US
Telephone Number : 208-323-7036
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2024
Last Update Date : 08/07/2024

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Directions to “ NOE RONQUILLO ” Practice Location

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