Provider Demographics
NPI:1477802304
Name:EIDE TOTH, JANNA MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JANNA
Middle Name:MICHELLE
Last Name:EIDE TOTH
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 1:37 RIVERPOINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASOTIN
Mailing Address - State:WA
Mailing Address - Zip Code:99402
Mailing Address - Country:US
Mailing Address - Phone:509-863-2205
Mailing Address - Fax:
Practice Address - Street 1:1904 19TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-743-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6596183500000X
AK2072183500000X
WAPH00061387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist