Provider Demographics
NPI:1003100116
Name:ROST, TONY DEAN (RPH, CDE)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:DEAN
Last Name:ROST
Suffix:
Gender:M
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 BLUE LAKES BLVD N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3374
Mailing Address - Country:US
Mailing Address - Phone:208-736-3321
Mailing Address - Fax:208-736-3321
Practice Address - Street 1:1611 BLUE LAKES BLVD N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3374
Practice Address - Country:US
Practice Address - Phone:208-736-3321
Practice Address - Fax:208-736-3321
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP42051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist