Provider Demographics
NPI:1003420449
Name:SEEWALD, MEGAN B (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:SEEWALD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:B
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 S WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1519
Mailing Address - Country:US
Mailing Address - Phone:760-317-7084
Mailing Address - Fax:
Practice Address - Street 1:3233 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4402
Practice Address - Country:US
Practice Address - Phone:208-501-7032
Practice Address - Fax:208-501-7026
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist