Provider Demographics
NPI:1619700598
Name:DOAN, PHU M (PHARMD)
Entity type:Individual
Prefix:
First Name:PHU
Middle Name:M
Last Name:DOAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 W PALM DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5822
Mailing Address - Country:US
Mailing Address - Phone:208-761-3538
Mailing Address - Fax:
Practice Address - Street 1:1625 S MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9355
Practice Address - Country:US
Practice Address - Phone:208-319-0600
Practice Address - Fax:208-319-0606
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7161871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist