Provider Demographics
NPI:1063829059
Name:DURTSCHI, ANGELA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:D
Last Name:DURTSCHI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6152
Mailing Address - Country:US
Mailing Address - Phone:208-523-0831
Mailing Address - Fax:208-525-4752
Practice Address - Street 1:700 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6152
Practice Address - Country:US
Practice Address - Phone:208-523-0831
Practice Address - Fax:208-525-4752
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist