MEDICARE: BRIAN ORA MINASIAN PHARM D

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	P4957	ID

General Provider Information

NPI Number	:	1811254709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ORA MINASIAN PHARM D

Provider Business Mailing Address
First Line	:	119 S VALLEY DR STE A
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-2985
Country	:	US
Telephone Number	:	208-442-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 S MIDLAND BLVD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-2601
Country	:	US
Telephone Number	:	208-442-1000
Fax Number	:	208-442-1091

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

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/16/2012

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Directions to “ BRIAN ORA MINASIAN PHARM D” Practice Location

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