Provider Demographics
NPI:1588950497
Name:ATER, MADELINE P (RPH)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:P
Last Name:ATER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 N TRAIL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4098
Mailing Address - Country:US
Mailing Address - Phone:208-939-6897
Mailing Address - Fax:
Practice Address - Street 1:4700 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0744
Practice Address - Country:US
Practice Address - Phone:208-939-5149
Practice Address - Fax:208-939-5282
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist