Provider Demographics
NPI:1730725839
Name:CURTIS, RONALD MARK (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:MARK
Last Name:CURTIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 S FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5217
Mailing Address - Country:US
Mailing Address - Phone:208-319-1043
Mailing Address - Fax:
Practice Address - Street 1:3395 S FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5217
Practice Address - Country:US
Practice Address - Phone:208-319-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120916183500000X
KY009367183500000X
FLPS59194183500000X
IDP6040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty