Provider Demographics
NPI:1285419192
Name:FARMER, CADE (RPH)
Entity type:Individual
Prefix:
First Name:CADE
Middle Name:
Last Name:FARMER
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 1:2940 W COBALT DR UNIT A106
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5987
Mailing Address - Country:US
Mailing Address - Phone:208-680-9168
Mailing Address - Fax:
Practice Address - Street 1:1219 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3701
Practice Address - Country:US
Practice Address - Phone:208-433-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM10911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist