Basic Information
| Provider Information | |||||||||
| NPI: | 1316216773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIDDLE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PHARM.D., BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4830 W GREENBRIER DR | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837053623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046386994 | ||||||||
| FaxNumber: | 8026540716 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837127791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083814100 | ||||||||
| FaxNumber: | 2083814101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | P7472 | ID | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.