Individual
MS. DEBORAH DIANNE HANSCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
1315 W DUNDEE ST, BOISE, ID 83706-4121
(208) 331-0922
Mailing address
1315 W DUNDEE ST, BOISE, ID 83706-4121
(208) 331-0922
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4926
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS5507
PHARMACIST CONTROLLED SUBSTANCE LISCENSE
ID
01
—
P4926
IDAHO STATE BOARD OF PHARMACY
ID
Enumeration date
10/31/2011
Last updated
10/31/2011
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