Provider Demographics
NPI:1538445614
Name:SATTERFIELD, DENICE KAY (PHARMD)
Entity type:Individual
Prefix:
First Name:DENICE
Middle Name:KAY
Last Name:SATTERFIELD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DENICE
Other - Middle Name:KAY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 S EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-321-2669
Mailing Address - Fax:208-321-2675
Practice Address - Street 1:265 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-321-2669
Practice Address - Fax:208-321-2675
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5514OtherIDAHO STATE BOARD OF PHARMACY LICENSE