Provider Demographics
NPI:1447708052
Name:NELSON, DENNIS W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N CURTIS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1331
Mailing Address - Country:US
Mailing Address - Phone:208-367-2167
Mailing Address - Fax:208-367-3915
Practice Address - Street 1:999 N CURTIS RD STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1331
Practice Address - Country:US
Practice Address - Phone:208-367-2167
Practice Address - Fax:208-367-3915
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist