Provider Demographics
NPI:1063240042
Name:DAUNER, ALEXIS RAENELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAENELLE
Last Name:DAUNER
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 1:851 W FRONT ST APT 506
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5827
Mailing Address - Country:US
Mailing Address - Phone:701-893-5366
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 1000
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6353
Practice Address - Country:US
Practice Address - Phone:208-706-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDI75615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist