Basic Information
| Provider Information | |||||||||
| NPI: | 1215516836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | BRANDEN | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1166 W STAFFORD DR | ||||||||
| Address2: | |||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089140961 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 POLE LINE RD W | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833015810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088141000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2021 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | NA | ID | N | Pharmacy Service Providers | Pharmacist | 183500000X | IN05342 | ID | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.