Provider Demographics
NPI:1285927848
Name:POXLEITNER, HEIDI M (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:POXLEITNER
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 1:1810 W PULLMAN RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4014
Mailing Address - Country:US
Mailing Address - Phone:208-882-3583
Mailing Address - Fax:208-883-8280
Practice Address - Street 1:1810 W PULLMAN RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4014
Practice Address - Country:US
Practice Address - Phone:208-882-3583
Practice Address - Fax:208-883-8280
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6081183500000X
WAPH00065291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist