Provider Demographics
NPI:1154533636
Name:MARCHETTI, DEBRA K (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:K
Last Name:MARCHETTI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:MARCHETTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3575 RIDGEWOOD RD.
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-380-2303
Mailing Address - Fax:208-232-3963
Practice Address - Street 1:1015 E YOUNG ST STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5237
Practice Address - Country:US
Practice Address - Phone:208-232-0049
Practice Address - Fax:208-232-3963
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDTPID015288Medicaid