Provider Demographics
NPI:1538157565
Name:SMITH, REBECCA J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 GOURLEY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4020
Mailing Address - Country:US
Mailing Address - Phone:208-484-7255
Mailing Address - Fax:
Practice Address - Street 1:10464 GARVERDALE CT
Practice Address - Street 2:STE 706
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5410
Practice Address - Country:US
Practice Address - Phone:208-323-1259
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5362183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy