Provider Demographics
NPI:1528052008
Name:THE PHARMACY DOCTOR, INC.
Entity type:Organization
Organization Name:THE PHARMACY DOCTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:ATTORNEY
Authorized Official - Phone:208-386-9292
Mailing Address - Street 1:1471 SHORELINE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6879
Mailing Address - Country:US
Mailing Address - Phone:208-386-9292
Mailing Address - Fax:208-386-9494
Practice Address - Street 1:1471 SHORELINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6879
Practice Address - Country:US
Practice Address - Phone:208-386-9292
Practice Address - Fax:208-386-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP39931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty