Provider Demographics
NPI:1124314927
Name:LINDBERG, NANCY A (RPH)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CLEVELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3627
Mailing Address - Country:US
Mailing Address - Phone:208-459-0521
Mailing Address - Fax:208-459-8506
Practice Address - Street 1:415 CLEVELAND BLVD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3627
Practice Address - Country:US
Practice Address - Phone:208-459-0521
Practice Address - Fax:208-459-8506
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDAHOMedicaid