Provider Demographics
NPI:1447710728
Name:ZIBROWSKI, ALYSSA RENAE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:RENAE
Last Name:ZIBROWSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:RENAE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:477 N WHITEWATER PARK BLVD APT C107
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5684
Mailing Address - Country:US
Mailing Address - Phone:309-721-4700
Mailing Address - Fax:
Practice Address - Street 1:149 W STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4911
Practice Address - Country:US
Practice Address - Phone:208-939-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123392183500000X
IDP8236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist